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Alcohol Awareness Toolkit

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Welcome to the Awareness Toolkit

This toolkit has been developed by Public Health Wales in partnership with Alcohol Concern using many of the resources and images provided by Change 4 Life. The toolkit is intended for use by any person or organisation who would like to raise awareness of alcohol use and misuse with colleagues, communities, families and friends. It will provide all the necessary tools and resources to plan, run and evaluate an alcohol awareness campaign.

Alcohol is a major preventable cause of death and illness. Around 1,500 deaths in Wales are attributable to alcohol each year (4.9% of all deaths).1 Problem use of alcohol can cause serious social, psychological and health problems, affecting work, social and personal relationships. Health risks associated with heavy drinking include:

Liver Disease of the liver

Alcohol Related Psychiatric Anaemia Disorders and Nutritional Disease Health Risks Associated with Heavy Drinking

Chronic Alcoholic Calcifying Dementia

Heart Muscle Damage cardiomyopathy

1. Public Health Wales Observatory 2014. in Wales 2014. Wales Profile.

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Alcohol in Wales and Hywel Dda

Alcohol has recently been identified as the third highest risk to health in developed countries (Alcohol Concern, 2006). The most recent data from the Welsh Government (2015)2 on referrals to substance misuse treatment services show an increasing trend in substance misuse with alcohol related referrals being the main problematic substance. An overview of these findings are provided below:

 There were 26,385 referrals for treatment of alcohol or drug misuse notified to the database in 2014-15. This represents a substantial rise in referrals, following two years of falling numbers (2011-12= 25,518; 2012-13= 24,691; 2013 – 14 = 24,001).  Based on 20,671 referrals (due to referral exclusions), 54 per cent of referrals were related to alcohol as the main problematic substance.  Males accounted for 62 per cent of referrals for alcohol and the median age for alcohol referrals was 42 years.

According to the Welsh Health Survey (2014) 39 per cent of adults in Hywel Dda report drinking above guidelines on at least one day per week and 23 per cent of adults report on at least one day in the past week. Table 1 below provides an overview of the Welsh Health Survey Data by county.

Adults who reported drinking above guidelines on at least one Adults who reported binge drinking on at least one day in the past week day in the past week

Source: Welsh Health Survey (2014) Per Cent Age- Age- Observed Standardised Observed Standardised Person Person Person Person Ceredigion 42 41 26 24 Pembrokeshire 35 36 18 20 Carmarthenshire 39 39 24 24 Hywel Dda 39 39 22 23 Wales 41 41 25 25

Drinking in children and young people remains a concern with 17% of males and 14% of females aged 11 – 16 in Wales drinking alcohol at least once a week. This is higher than in Scotland, Ireland and England.3

2. Welsh Government (2015) Treatment Data – Substance Misuse in Wales 2014 – 2015 3. Public Health Wales Observatory 2014. Alcohol and Health in Wales 2014. Wales Profile.

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Why do people drink?

There are a number of reasons why people drink alcohol and these reasons may vary considerably from person to person. By beginning to think about these different reasons, you will begin to gain some useful insight into the nature of alcohol use in our culture. It may also give you ideas for conversations you could have to encourage people to start thinking about their relationship with alcohol. Listed below are the most common reasons that people give for drinking on a regular basis: People often enjoy a drink to ‘wind down’ and it is seen as a Reward reward after a stressful day at work

Some consider having a drink as ‘me time’ once the children To Relax are in bed, or as one consumer described it, ‘part of my relaxation package’.

A number of people acknowledge that their patterns of routine drinking become difficult to disrupt. This leads to a Routine belief that they might be too set in their ways to be able to break the pattern.

In this context, alcohol is frequently described as an Alcohol Enhances The ‘essential ingredient’, helping consumers to ‘fit in’ or be more Social Experience confident in social situations.

People often use alcohol as a way to manage stress, anxiety Coping Mechanisms and/or depression.

 Boredom  Feeling down Additional Reasons  Pressure from others for example: ‘oh go on I am having one’  Cheaper having a drink at home and more convenient

What about older adults?

As people get older, their bodies change so when alcohol is consumed it is broken down more slowly, and they become more sensitive to the effects of alcohol.

There are many factors and life changes associated with alcohol use by older adults. Factors associated with higher rates of alcohol use

Emotional and social Health Other  Bereavement  Physical disabilities  Family history  Loss of friends and social  Chronic Pain  Personality status  Insomnia  Long term prescribing  Sensory deficits  Available finances 4

Factors associated with higher rates of alcohol use

Emotional and social Health  Loss of occupation  Reduced mobility  Impaired ability to function  Cognitive impairment  Family conflict  Disrupted sleep  Reduced self esteem  Caring for an elderly partner or family member  Loss of independence  Needing  Stress  Depression  Social Isolation and loneliness  Retirement

Adapted from Dar 2006 Dar, K. (2006). Alcohol use disorders in elderly people: fact or fiction? Advances in psychiatric treatment 12(3):173-181.

Alcohol and Medication

The combination of alcohol with medications can also cause problems.

Older people receive more prescriptions than any other age group and are often dispensed multiple medications. Many medicines, both prescription and over the counter, interact with alcohol.

These interactions may increase the effect of a medicine (e.g. the sedative effect of a hypnotic), exacerbate a side effect (e.g. the drowsiness associated with anti-histamine use), or result in a new syndrome (e.g. the unpleasant effects of combining alcohol and some antibiotics).

DID YOU KNOW?

 Over 45s are three times more likely to drink alcohol every day.  People who work are more likely to drink alcohol than unemployed people.  Around 200,000 people come to work with a hangover every day.  Alcohol is the second biggest risk factor for cancer after smoking.

Alcohol Concern UK

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Benefits to cutting back on alcohol

There are loads of benefits to cutting back on the alcohol. The most important one is the reduced risk to your health, but there are lots of others too – you might be surprised!

Heavy drinking can be linked Too much alcohol can really to depression, and pile on the pounds. If you sometimes a hangover can drink 10 pints a week, you leave you feeling low. could be taking on more than 120,000 calories a year. If you already feel anxious or sad when you are sober, And there are more calories drinking can make this in a single measure of spirits worse. than in the same volume of single cream. So cutting down may put you in a better mood generally. So if you cut back you will start to feel in better shape.

Feel In Better Mood Better Shape

Benefits to cutting back on alcohol

Health Sleep Soundly

Once you start cutting back, Alcohol can disrupt your you will probably notice the sleep patterns and stop you benefits quite quickly: from sleeping deeply. Feeling better in the mornings, having more So cutting down on alcohol energy and feeling less tired should help you feel more during the day, and your skin rested when you wake up. may start to look better.

Cutting down on alcohol can reduce the chances of suffering from more serious health harms such as: alcohol-related cancers, heart disease, high blood pressure, stroke, liver 6 Source: disease, pancreatitis and NHS Choices, UK reduced fertility.

Why your setting should get involved…

Workplace:

Alcohol can play a significant role in and around the workplace. It is often perceived as a stress- reliever and an antidote to the daily pressures of demanding roles, as well as a way to socialise and to network with colleagues and clients. However, drinking can lead to decreased organisational productivity and long-term health problems.

Up to 17 million working days are lost each year because of alcohol-related sickness and the cost to employers of sick days due to drink is estimated at £1.7bn.4 The total annual cost to the economy is estimated to be £7.3bn (2009/10 prices).5

The workplace provides an ideal setting to target interventions around raising awareness of alcohol related harm and on reducing alcohol consumption – it provides access to an established population of adults, and provides a great opportunity to improve the health and wellbeing of staff.

The impact of alcohol on the workplace:

 Raised blood alcohol levels while at work affect both efficiency and safety - meaning increased likelihood of mistakes, errors of judgement and accidents.  Hangovers affect attendance and performance.  Persistent heavy drinking may lead to serious social, psychological and medical problems which are associated with work attendance and performance – for example, increased sickness absence.

Source: Alcohol in the workplace: Institute of Alcohol Studies Factsheet, 2014

4. National Institute for Health and Clinical Excellence (June 2010), 'Business case: Alcohol-use disorders: preventing harmful drinking', p. 13 5. Home Office (November 2012), 'Impact Assessment on a minimum unit price for alcohol', p. 5 7

Communities:

Communities provide an ideal setting to target interventions around raising awareness of alcohol related harm and on reducing alcohol consumption. It provides access to community groups and organisations as well as families and individuals within specific neighbourhoods.

The impact of alcohol on communities:

 Health – liver disease, certain cancers and dementias, depression and

anxiety, birth defects.  Crime – disorder, violence, domestic abuse, vandalism and anti social behavior.  Consequences – loss of driving licence, higher car insurance premiums, loss of employment.

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How to get involved…

There are many ways for you or your organisation to get involved with the campaign and promote key messages to your work colleagues, family and wider community. The following section of the toolkit will outline some ideas which will be very easy to introduce and some that may require a little more effort.

All the tools and information needed to put your campaign together are provided in the themes section of this toolkit. This includes an evaluation form which we would be grateful if you could complete and return after your campaign to help us understand how effective the campaign has been across all organisations involved.

The following resources are also available for download at (control + click to follow link) www.drinkwisewales.org.uk/downloads/

 2015 Alcohol Awareness Week toolkit (English)  2015 Alcohol Awareness Week toolkit (Welsh)  supporters’ booklet (English)  Dry January supporters’ booklet (Welsh)  Dry January poster (English and Welsh)  Dry January sponsorship form (bilingual)  Public Health Wales Dry January workplace challenge handbook (English)  Public Health Wales Dry January workplace challenge wall chart (English)  Change 4 Life alcohol advice booklet (English)  Change 4 Life alcohol advice booklet (Welsh)  Change 4 Life alcohol poster (bilingual)  ‘What’s in your drink?’ unit information poster (bilingual)  alcohol conversation starter cards (English only)  Hair of the Dog poster (English only)

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KEY MESSAGES FOR ALCOHOL AWARENESS CAMPAIGNS

39% of the adult population in Hywel Dda admit to drinking above recommended guidelines on at least one day in the past week (Welsh

Health Survey, 2014).

Drinking over recommended guidelines daily or on most days of the week increases the chance of developing liver disease, certain cancers, dementias and developing alcohol dependency.

Sticking within the recommended daily guidelines (men: 3-4 units; women: 2-3 units) and having at least 2 alcohol-free drinking days a week means there is only a low risk of harm.

If alcohol has crept up on you, get sneaky and cut back. Try to find activities to wind down and relax that don’t involve drinking on at least 2 days a week and on days that you do drink, try to do so sensibly by using the tips for swapping and nights out at Change4Life Wales | Alcohol

Also find local information and advice on Hywel Dda University

Health Board Hywel’s House website at Hywel Dda University Health Board

| Hywel's House

If you want to take up the challenge to give up drinking for a month, consider having a ‘Dry January’ www.dryjanuary.org.uk

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CAMPAIGN THEMES

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1. CONVERSATIONS ABOUT ALCOHOL…

Starting a conversation about alcohol consumption and the effects it may have on health, home, family and working life may be challenging. Use the resources below to assess how much people are really drinking, to ask open questions about drinking behaviour or to find out if there is a specific issue that may be of concern. Use the signposting information at the end of this toolkit to ensure those that are motivated to change, or those with harmful levels of drinking, are referred to the appropriate services.

Resource to support a conversation about alcohol consumption:

To help people understand how harmful their drinking is you may want to ask them to complete a short questionnaire called AUDIT C.6

AUDIT C is a short form version of the Alcohol Use Disorders Identification Test (AUDIT) (WHO, 2001) which was developed to screen for excessive drinking and in particular to help practitioners identify people who would benefit from reducing or ceasing drinking. The majority of excessive drinkers are undiagnosed and often present with symptoms or problems that would not normally be linked to their drinking. As a first step in starting a conversation about alcohol consumption use AUDIT-C, below, to quickly assess how risky individual drinking patterns are.

Each question (see below) has a set of responses to choose from, and each response has a score ranging from 0 to 4. The score for each question should be entered onto the form (right- hand column) and summed to give a total score. The total score will allow classification of people into three groups: low risk, increasing risk or hazardous drinking and harmful/alcohol dependent.

For clients with AUDIT-C scores 6 – 8 and no prior alcohol treatment, it may be useful to start a conversation about alcohol consumption using the resources included in this section. Those whose score indicates that they are at high risk (score of 7-8) should receive more intensive treatment which may commence with feedback of their results and . A total score of 9 or more is a possible indicator of hazardous and harmful alcohol use, as well as possible requiring a full diagnostic assessment and/or referral to a specialist drug and alcohol treatment service (see appendix for referral information).

6. AUDIT – C is the short form version of the Alcohol Use Disorders Identification Test (AUDIT, WHO 2001) 12

Once people have had an opportunity to think about and assess their drinking use the

CONVERSATIONS ABOUT ALCOHOL Framework (page 15) to: a) ask about drinking patterns; b) offer some suggestions/advice; c) signpost to support services.

AUDIT – C

Scoring system Your Questions score 0 1 2 3 4 2 - 4 2 - 3 4+ How often do you have a drink containing Monthly times times times Never alcohol? or less per per per month week week

How many units of alcohol do you drink on a 1 -2 3 - 4 5 - 6 7 - 9 10+ typical day when you are drinking?

Daily How often have you had 6 or more units if Less or female, or 8 or more if male, on a single Never than Monthly Weekly almost monthly occasion in the last year? daily

Scoring: SCORE A A total of 5+ indicates increasing or higher risk drinking

An overall total score of 5 or above is AUDIT-C positive

If you want to assess individuals for specific symptoms due to

drinking, the full AUDIT can be used as a brief assessment for

symptoms of and dependence (See following page).

Pending New Guidance on AUDIT C:

In the coming months new guidance will emerge for using AUDIT C with older adults and scores will be grouped differently as per the ranges below:

 0 – (non drinker)  1 – 3 (low risk)  4 – 6 (hazardous drinking)  7 – 9 (harmful drinking)  10 – 12 (potentially addicted)

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Remaining AUDIT questions:

SCORE ‘A’ CARRIED OVER FROM ABOVE:

Scoring system Your Questions score 0 1 2 3 4 Daily How often during the last year have you found Less or that you were not able to stop drinking once you Never than Monthly Weekly almost monthly had started? daily Daily How often during the last year have you failed to Less or do what was normally expected from you Never than Monthly Weekly almost monthly because of your drinking? daily Daily How often during the last year have you needed Less or an in the morning to get yourself Never than Monthly Weekly almost monthly going after a heavy drinking session? daily Daily Less How often during the last year have you had a or Never than Monthly Weekly almost feeling of guilt or remorse after drinking? monthly daily Daily How often during the last year have you been Less or unable to remember what happened the night Never than Monthly Weekly almost monthly before because you had been drinking? daily Yes, Yes, Have you or somebody else been injured as a but not during No in the the result of your drinking? last last year year Yes, Yes, Has a relative or friend, doctor or other health but not during worker been concerned about your drinking or No in the the suggested that you cut down? last last year year

SCORE B

TOTAL SCORE (A+B) =

Scoring: 0 – 7 Lower risk 8 – 15 Increasing risk 16 – 19 Higher risk 20+ Possible dependence

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Conversations about alcohol7 Hints and Tips What are your thoughts about your drinking? (you can use the AUDIT C score to start the conversation). Did you know...? ASK Are you interested in making a change to the amount of  The NHS recommends that men drink no more alcohol you drink? than 3-4 units a day and women no more that 2-3 units a day. What are the consequences of continuing to drink at your current level?  It is recommended that men and women have a Is there anything that concerns you about your drinking? least two alcohol-free days per week. ADVISE

 A unit of alcohol is less than you think: a half pint What benefits do you think you would experience if you of beer or a small glass of wine or a single shot of reduced your drinking? spirits. Some people find it helpful to keep a diary of their drinking  You can binge drink more easily than your think. for a few days, to keep track of what and how much they Binge drinking is when you consume double the drink. Would this be helpful for you? daily recommended limit in one session. Have you considered talking to anyone about reducing your  Alcohol contains hidden calories. A pint of larger drinking? It can help to talk to family, friends or a health professional. Or contact the Wales Drug and Alcohol contains the same calories (170cal) as a sausage roll ACT and a glass of red wine (175ml) contains the same helpline 0808 808 2234 calories (120cal) as a slice of cake. For more information on alcohol and support services available go to Hywel’s House Online Healthy Lifestyle Resource Centre: www.hywelddahb.wales.nhs.uk/healthy- wednesday

7. Source: Hywel’s Handbook to Health

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2. MYTH BUSTING

To raise awareness of the myths around alcohol distribute and discuss the MYTH BUSTER factsheet below or use to create a display.

Myth True or Facts False? The recommended daily alcohol limits are 2 - 3 units for a woman and 3 - 4 units for a man. These amounts are intended to be spread out through the week, with at least two alcohol- I can save up my free days in every seven. FALSE drinks for the Saving up your units from the week and drinking them all at weekend once could leave you with a nasty hangover in the morning and some embarrassing memories of the night before, as well as increasing your risk of injuries, fights and accidents.

Alcohol affects the brain like an anaesthetic, impairing I can drink lots judgement and coordination, and slowing reaction times, and so increasing your risk of accidents and injuries. of alcohol and FALSE still be in control

Temporary impotence (or ‘brewer’s droop’) after a bout of drinking is a common problem experienced by men.

Alcohol Men who drink heavily over a longer period may experience a improves sexual FALSE loss of libido and potency, shrinking of the testes and a reduction in penis size. performance Long-term heavy alcohol use in women may result in fertility problems, and the shrinking of breast and sexual organs.

Alcohol is a depressant not a stimulant. It slows down how you think, move and react, and is unlikely to give you an energy lift. Alcohol gives FALSE me a boost Mixing alcohol with sugary energy drinks may give you a temporary boost, but this is likely to be followed by greater fatigue and sugar cravings.

Alcohol may make you feel sleepy and reduce the time it takes to fall asleep, but the quality of sleep is often poor.

Alcohol helps Studies show that alcohol consumed as much as six hours TRUE/FALSE me sleep before bedtime will increase wakefulness during the second half of your sleep, and keep you from getting the deep sleep you need.

Drinking coffee may make you feel more awake, but it will not make you less drunk or cure a hangover. Plus, coffee is diuretic- it makes you pass water- and so may even worsen Coffee sobers FALSE post-drinking dehydration. me up Drinking caffeine may also make it harder for you to realise whether you are still drunk, leading to poor decision-making, such as driving whilst there is still alcohol in your blood.

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3. HOW MUCH ARE YOU DRINKING?

Conversation Starter Activities:

1. Ask the person if they have seen an alcohol unit wheel (page 35) before and tell them it is great for working out the number of units in drinks. Ask the person what their favourite tipple is and use the alcohol unit wheel to tell them how many units and calories are in 1 and 2 servings. Tell them the recommended daily guidelines and relate to the number of units in their favourite tipple.

2. Ask them to pour their usual amount of wine or spirit into a or glass. Use an alcohol unit beaker (page 35) to measure the number of units contained in their poured serving. Tell them the number of units they poured and relate to the recommended daily guidelines. (Props required: wine glass, tumbler glass, unit beaker, mock wine in an old wine glass or jug, mock spirit in an old spirit bottle or jug).

3. Ask them to pour what they think is 1 unit of wine or spirit into a wine glass or tumbler glass. Use an alcohol unit beaker to measure the number of units contained in the serving. Tell them the number of units they poured and relate to the recommended daily guidelines. (Props required: wine glass, tumbler glass, unit beaker, mock wine in an old wine glass or jug, mock spirit in an old spirit bottle or jug).

4. Ask people to guess the number of units contained in a range of alcoholic beverages e.g. a bottle of whisky, a shot of tequila, a . People could note down their name and the number of units they think are on the table, you could allocate a prize to the winner.

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What are the recommended guidelines...?

All individuals are advised to take at least TWO ALCOHOL FREE DAYS A WEEK

Did you know?

One unit of alcohol is 10 milliliters (1 centilitre) by volume, or 8g by weight, of pure alcohol.

A Wales survey in 2010 by Alcohol Concern Cymru found that over half (52%) of drinkers did not know the recommended alcohol guidelines. In addition, the Welsh Health Survey published in 2014 found that 41% of adults in Wales reported drinking more than the recommended daily guidelines on at least one day in the past week.

Units don’t work like reward points. You can’t store them up for a big night out. Drinking large amounts in one go cause’s additional physical damage.

Use the following resources to understand units and to help keep track of drinking (control + click to follow link):

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Using units is a simpler way of representing a drink’s alcohol content,

which is usually expressed by the

standard measure ABV, which stands for alcohol by volume and is a measure of the amount of pure alcohol as a percentage of the total volume of liquid in a drink.

You can find the ABV on the labels of cans and bottles, sometimes written as “vol” or “alcohol volume” or you can ask bar staff about particular drinks. For example, wine that says “12% ABV” or “alcohol volume 12%” means that 12% of the volume of that drink is pure alcohol.

You can work out how many units there are in any drink by multiplying the total volume of a drink (in ml) by its ABV (which is measures as a percentage) and dividing the result by 1,000.

Strength (ABV) x Volume (ml) ÷ 1,000 = units.

For example, to work out the number of units in a pint (568ml) of strong lager (ABV 5.2%):

5.2 (%) x 568 (ml) ÷ 1,000 = 2.95 units

To make things easier NHS Choices have developed a drinks tracker for the iPhone and an alcohol unit’s calculator to help you keep track and provide personalised feedback.

For more information go to:

http://www.nhs.uk/Livewell/alcohol/Page s/Alcoholtracker.aspx

See the guide (left) to find out how many units are in your favourite drink.

‘Regularly’ means drinking this amount every day or most days of the week. 19

4. SENSIBLE DRINKING - key messages...

 Eat something  Eating food with your alcohol helps you to pace yourself, and a full stomach will slow down the effects of the alcohol.

A drink with a meal only

Try only drinking at home with your main meal. And not before or after you’ve eaten.   Pace yourself Enjoy a drink slowly. You don’t have to join in with every round. Take a break between drinks and have a low-calorie soft drink or glass of water in between, which will also help you stay hydrated.   Watch out for strength  Try drinking low-alcohol and alcohol-free drinks.   Watch your size You can still enjoy a drink, just have less. Try a smaller bottle of beer over a can or a small glass of wine rather than a large one. Wine glasses today are bigger than ever and can easily hold a third of a bottle.

A drink with a mixer Get more out of your drink by adding a low-calorie mixer to make it last longer.

 Keep track  Statistics suggest that those of us who drink at home often pour much more than the standard pub measures of drinks, and are less likely to stick to the recommended daily limits. Try keeping a drinking diary – you can find one here: Drinking Diary   Hydrate  Alcohol is a diuretic, which means it will dehydrate you. Drink water regularly whether you’re drinking at home or in a pub.  A cup of tea or coffee When you get the urge to pour yourself a glass, switch on the kettle and enjoy a cuppa instead. The chances are you will not feel like an alcoholic drink afterwards. Drinking above the lower-risk guidelines and drinking heavily regularly on just one or two days a week can also be harmful to our health in the long term.

Take a break  Government advice is to have at least two alcohol-free days every week. It is ok to turn down alcohol.

Not everyone drinks alcohol: it’s OK to say no 20

5. OUR HEALTH AND ALCOHOL

What is the problem with drinking over recommended limits?

The table below details some of these major alcohol-related health effects and some relevant facts:  Fifth biggest killer in England and Wales, and is the only major cause of death still increasing year-on-year. Liver disease  UK liver cirrhosis increased more than five-fold between 1970 and 2006. In contrast, in France, Italy and Spain the number of deaths decreased markedly and are now lower than those in the UK.

 High intake of alcohol can have a negative effect on the digestive system, Digestive including (inflammation of the stomach lining), stomach ulcers, system reflux leading to oesophagitis (inflammation of the lining of the food pipe) and pancreatitis (inflammation of the pancreas).

 Alcohol is a leading cause of mouth cancer, second only to tobacco. It is estimated that somewhere between 25% and 50% of cancers of the head and neck are a result of alcohol. Cancer  Up to 20% of breast cancer cases in the UK can be attributed to alcohol.  In an ongoing study of 500,000 people in ten European countries, it was found that for every two units consumed a day, the risk of bowel cancer increased by 8%.

 Whilst drinking in moderation may offer some protection against heart disease for at risk groups i.e. men over 40 and women past the Heart disease menopause, this should not be viewed as a green light to start drinking or increase consumption. There are better ways to protect against heart disease, like regular exercise and regularly eating fruit and vegetables.

 Heavy drinking can contribute to osteoporosis (a disease which causes thinning of the bones) The bones  Gout (swelling of the joints) can be exacerbated by heavy drinking, and it has been reported that this condition is becoming increasingly common in men in their twenties as a consequence of alcohol misuse.

 Alcohol is a depressant drug and prolonged drinking can lead to profound and long-lasting mood swings. Whilst low doses of alcohol appear to Mental health cheer people up, higher doses may cause psychological distress.  The World Health Organisation estimates that the risk of suicide when a person is abusing alcohol is eight times greater than if they were not.  Excessive drinking is a risk factor for Dementia.  Someone regularly drinking more than the recommended levels of alcohol significantly increases their risk of developing dementias such as vascular dementia and Alzheimer’s disease. You don’t need to be an alcoholic to have this higher risk. Dementia  People with alcohol related dementias also tend to be middle aged, typically in their 50’s or younger and men more often than women. People who misuse alcohol also tend to suffer head injuries from falls or fights and often have a poor diet. These all contribute to alcohol dementia. 21

 When a woman drinks alcohol during pregnancy, the alcohol passes from her blood stream through the placenta and into the baby’s blood stream. When a woman is drinking regularly during this time, the alcohol can disrupt the baby’s normal development in the womb.  Drinking alcohol during pregnancy can affect: - the way the baby develops in the womb - the baby’s health at birth - the baby’s susceptibility to illness in infancy, childhood, adolescence and adult life - the child’s ability to learn (learning difficulties).  The effects of drinking alcohol are most harmful for the baby when a woman drinks just before and during pregnancy.  When a woman cuts down or stops drinking at any point during Sexual and pregnancy, it can make a difference to the baby. However, in some Reproductive instances, once the damage has been done, this cannot be reversed. Health  Heavy drinking is often related to unprotected sexual intercourse, which may result in an unplanned pregnancy and sexually transmitted infection.  Alcohol lowers sperm count in men and fertility problems in women.  It is important that you share information with your healthcare professional(s) about your drinking. Depending on your situation, your healthcare professional will then be able to offer you appropriate information and support.  The Department of Health states that ...”pregnant women or women who are trying to conceive should not drink alcohol at all”. If they do choose to drink, to minimise the risk to the baby, they should not drink more than 1-2 units of alcohol once or twice a week and should not get drunk.

 Dehydration and lack of proper sleep can wreck skin and hair. It expands Early aging blood vessels, causing thread veins and other physical symptoms.

Sleep  Alcohol can help us nod off but even small amounts can prevent the deep problems sleep that we need to feel alert and refreshed.

Resources to support a health and wellbeing campaign can be accessed by following embedded links in each poster (control + click to follow link).

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Alcohol and wellbeing

Many people believe that alcohol helps them to feel good. Unfortunately, the realities of a hangover, difficulties at home (including in the bedroom) or at work, or a conviction for driving under the influence show that very often this is far from the case.

There is also the issue that those who consume high amounts of alcohol are also vulnerable to higher levels of mental ill health. Although drinking alcohol in the short-term it may provide people with a relatively easy coping strategy for underlying mental health issues such as stress, depression or anxiety, the research suggests that long-term alcohol misuse is damaging. Not only may it serve to worsen the very symptoms it is being used to dampen, but it is associated with a range of other mental health consequences. These include depression, anxiety, suicide, risk-taking behaviours, personality disorders and schizophrenia.

But plenty of non-alcohol related activities are known to boost how you feel. There is strong evidence to suggest that incorporating the ‘5 ways to wellbeing’ (see following page) into your everyday life will help you to feel good and function well. So instead of drinking to relax or wind down after a stressful day, try doing something that includes one or more of the ‘5 ways’. It may not work overnight, but the morning after the night before is likely to be a lot better!

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The ‘5 ways to wellbeing’

Some suggestions to start you thinking:

For more information on using this resource go to: http://www.wales.nhs.uk/sitesplus/888/page/61014

Or use the worksheets on the following pages to assess what you are doing now and to plan your 24 “5 WAYS TO WELLBEING” .

5

loads wellbeing

Five ways to waysFive

4

lot a quite

3

fun. being as a fair amount fair a fitness. and mobility and personal plans for the for planspersonal and

help you appreciate what matters to you. to matters what appreciate you help activity

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6. ALCOHOL FREE DAYS

Most people do not drink alcohol every day, but if you do, try having some days off when you do not drink at all. This is a simple way to cut your regular drinking. Just make sure you do not increase the amount you drink on the other days.

‘Don’t let alcohol sneak up on you – Have at least 2 alcohol free days each week’

Here are some tips to help……..

How to de-stress without alcohol:

 Exercise is an excellent way to de-stress. Even a brisk walk can clear your head.

 Try replacing an evening at the pub with another activity, maybe the cinema, theatre?

 Having a nice warm soak in the bath will relieve tension from your body.

 Get an early night to leave you fresh and alert the next day.

 Have a mocktail or two… (see recipes on next page)

Access the below resources by following the embedded links (control + click to follow link)

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Mocktails

VIRGIN

1 part orange juice 1 part lime juice 3 parts sour mix (1 cup caster sugar, 2 cups water, 2 cups freshly squeezed lemon juice. Stir together) Fill a cocktail shaker with ice. Add the ingredients and shake well. Strain into an ice-filled . To make a long drink, use a and top up with lemonade.

SAFE SEX 1 part peach juice 3 parts pineapple juice 3 parts orange juice A squeeze of lime juice Fill a cocktail shaker with ice. Add the ingredients and shake well. Strain into an ice-filled highball glass. Garnish with a slice of lime and a strawberry. TOOTHLESS SHARK 1 part lime juice 1 part grenadine 6 parts orange juice Three-quarter fill a highball glass with orange juice. Add the lime juice and stir well. Slowly pour in the grenadine. Do not stir.

SHIRLEY TEMPLE.

Ginger ale Grenadine A wedge of lemon Fill a highball glass with ice. Add a couple of dashes of grenadine before filling with ginger ale. Squeeze the juice from the lemon wedge into the drink. Garnish with a cherry

VIRGIN CAIPIRINHA 1 lime, diced 1 lemon, diced 1 orange, diced 2 teaspoons sugar Ginger ale Place the fruit in a jug. Add the sugar and stir until juices are released from the fruit. Strain into ice- filled tumblers and top up with ginger ale. Garnish with a sprig of mint.

EGG NOG 1 egg (use only lion marked eggs) 2 tablespoons caster sugar ½ pt milk ½ teaspoon vanilla extract Beat the egg yolk with the sugar, vanilla and milk. Whisk the egg white until fluffy. Fold the egg white into the yolk mixture. Serve in tumblers, sprinkled with a little cinnamon. ON THE BEACH ¼ Honeydew melon (make sure it's ripe) 100 g raspberries 100 ml orange juice 10 ml lime juice Grenadine Lemonade Blend the melon, raspberries, fruit juice and grenadine with a handful of ice. Pour into an ice- filled highball and top with lemonade. Stir well. Garnish with a melon ball on a stick. PINK PINA 2 parts pineapple juice 1 part coconut cream 1 part pink grapefruit juice Blend the coconut cream and fruit juices together with ice. Pour into highball glasses and serve with a slice of grapefruit

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7. HOME DRINKING

There has been a noticeable shift towards drinking away from licensed premises in recent years. Research carried out in Wales by Alcohol Concern in 2010 found that 50% of drinkers said that they drank only at home, and an additional 21% drank equally at home and in the pub.8

Why are we choosing to drink at home?

 Affordability and availability of alcohol in supermarkets and off licences – 46% of drinkers in Wales have said they drink at home because it is cheaper. This has led to the practice of ‘pre- loading’ e.g. consuming alcohol at home before going out to drink – research suggests that those who ‘pre-load’ consume considerably more alcohol over the course of the night and are 2.5 times more likely to end up in a fight.8  Increasing popularity in home based entertainment e.g. television, electronic games and listening to music  Home entertaining e.g. barbecues, parties, dinner with friends  Convenience – can easily help ourselves to drinks, can relax more at home, childcare  Safety - perception of alcohol related violence around bars and clubs  Stress release/reward  Introduction of the smoking ban  Lifecycle – too old to go to pubs and clubs

Home drinking issues:  Larger measures per drink  Unsupervised environment  Hidden impact e.g. Domestic Violence. Scientists have linked aggression to the consumption of too much alcohol.9 More worryingly scientists have also identified a strong link between alcohol and domestic violence.10  Social isolation

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Home drinkers tend not associate themselves with the images seen in the media of binge drinking and anti social behaviour, but this does not mean they will not suffer from the same effects of excessive alcohol consumption.

Home drinking is also seen as a solution to drink driving but we could still be getting into our car the following morning over the drink drive limit without even realising.

Taking risks Whilst far fewer people are taking the risk of drink-driving at night, more are getting into their cars in the morning, without realising they could still be over the legal limit to drive.11 Research suggests people are failing to understand that just because you have been to sleep, it does not mean you are no longer affected by alcohol.

Know our units If we are thinking about driving the morning after we have been drinking, it is best to consider how much we have drunk and how late into the night it was before we finished our last drink. It is important to remember the strength of different drinks can vary greatly. There is no fail-safe way to guarantee that all the alcohol we have drunk has left our system, so it is important not to take risks. When we are under the influence of alcohol the skills we need for driving, such as hand eye coordination, are impaired to some extent. We are more likely to have an accident and be putting ourselves and others at risk.

Sleeping it off? Whether it is okay to drive the next morning will depend on how much alcohol we have consumed and if we have left enough time for our system to remove the alcohol. In general, alcohol is removed from the blood at the rate of about one unit an hour - this does vary from person to person. It can also depend on our size and gender, as men tend to process alcohol quicker than women; how much food we have eaten; the state of our liver, and our metabolism (how quickly or slowly your body turns food into energy).

We cannot speed up the process There is a mixture of mechanisms at work when our body processes alcohol. There is nothing we can do to speed up the rate alcohol leaves our system - having a cup of coffee or a cold shower will not do anything at all to get rid of the alcohol. They may make us feel slightly different, but will not have eliminated the alcohol in any way.

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What about our children?

Ever wondered who is the biggest influence on your kids? Your own habits will have a big influence on how your child drinks or doesn’t, in the future, so set good examples and stick to sensible alcohol consumption.

Talk and listen to your kids – talking builds up trust and helps you talk. Try and find out how much your children really know about alcohol. Make sure any information you give them is accurate, and let them know both the positives and negatives about drinking.

Keep an eye on it – when you are drinking at home or at a party, try measuring your drinks rather than free pouring, so you can keep an eye on how much you have had to drink. By using the unit measuring cups you can be sure how much you are drinking.

Don’t punish the children for your bad behavior – why should they suffer your hangover? Make sure you are able to get out of bed on a Saturday morning and are fit to drive so you can get them to swimming or football practice. You want to enjoy it as much as they do.

Home drinking - simple cutting down ideas Alcohol Advice | Drinkaware - for the facts about Alcohol

1. Keep track of the alcohol units you’re drinking Activity - unit calculator

2. Know what you’re buying If you are a wine drinker a really easy way of cutting down on alcohol is to buy small (125ml) glasses for the house rather than the large 250ml ones.

3. Home measures It is worth buying an alcohol measure as there will be no more guess work involved and you will be able to keep track of how much you are drinking. Activity – unit measure cup

8. Drinkwise Wales Glance Sheet - Helping Yourself? 9. and 10. Institute of Alcohol Studies website. Binge Drinking and Europe report. 11. Department for Transport website. Reported road casualties in Great Britain: annual report 2014

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8. Alcohol Concern “Dry January” Campaign

Banish the booze in January and make a healthy start to the new year by signing up to the challenge of going booze free for 31 days.

It’s a great way of bringing up the topic of alcohol in a gentle, non-threatening way as it doesn’t single anyone out. It is aimed at the huge number of people who are steadily drinking a bit too much, too often, which accounts for around 10,000,000 people in the UK. Regularly drinking over the recommended amounts can lead to health issues, but by giving up for just one month you can have some positive benefits and have a chance to think about your drinking habits.

By taking on the challenge it’s your chance to lose weight, feel better, save money and make a difference. With no hangovers you will find time and energy you never knew you had. So go on, take time out, get thinking about your drinking and prove to yourself that you can say no to a drink or two. Alcohol Concern will be there every step of the way, offering support, resources etc.

This is your chance to ditch the hangover and prove to yourself that you can say no to a tipple or two. To access support and a fundraising pack sign up at: http://www.dryjanuary.org.uk/

It is important to remember that this challenge is not a medical detox or for those with dependency issues. If you are worried about yours or someone else’s drinking please speak to your GP or contact DAN 24/7 on 0808 808 2234.

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ORGANISING

YOUR

CAMPAIGN

Stakeholders

Evaluation Audience

Vehicles of Resources Delivery

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Tips for organising and running you’re alcohol awareness campaign/s:

 Contact relevant partners/stakeholders to support activities

 Ask your immediate team for help and assistance

 Get approval for your campaign from your organisation and access any available funds to support implementation

 Access campaign support materials form national and local alcohol organisations

 If creating your own materials – proof read and develop bilingually

 Map out settings to target with campaign

 Distribute materials in advance of alcohol awareness week’s / months

 Create a checklist for the campaign to aid planning and implementation

 Always evaluate to help assess what has been achieved and to support the planning of future campaigns.

Methods of promoting the messages:

1. Internet/Intranet and Newsletter

A great way to spread the messages of the campaign is to regularly post information leading up to and during the campaign on your internet / intranet page or via emails and/or newsletters.

2. Poster Displays

Most settings e.g. workplace, schools, post offices, community centres etc have areas where posers / information / display boards can be placed.

See www.drinkwisewales.org.uk/downloads/ for other posters and leaflets, alongside those in this toolkit, to display.

Points to remember:  Make sure literature is well placed, somewhere where people will see it.  Remember that the successful campaigns rely on more than one method of promoting messages. 34

3. Engagement

A great way to engage with people is to set up a stall or a protected space which gives you a real opportunity to start a conversation. An excellent way of bringing up the subject of alcohol use is to engage individuals with an interactive tool. See Alcohol Awareness Week Toolkit-2015.pdf for more activities alongside those in this toolkit.

Additional Resources (control and click to follow link):

4. Social Networking

Twitter, Facebook and other forms of social media are effective methods of communication. You could use these avenues to provide links to useful online resources in order to reinforce the messages and to support people to change their relationship with alcohol.

See Alcohol Awareness Week Toolkit-2015.pdf for more ideas.

Follow Alcohol Concern Cymru: @ACCymru Follow Drink Wise Wales: @DrinkWiseWales

5. Press Release

National campaigns are often suitable for demonstrating your organisation’s commitment to improving the health and wellbeing of your workforce/community. Why not demonstrate your commitment by including a press release from your organisation supporting the key messages of the campaign

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The Do’s and Don’ts of Alcohol Awareness Events

- Do be strategic about when and where you run them. Set up in a busy area such as a canteen or staff room, shopping centre, community event

- Make the stall / space appealing, eye catching and enticing;

- Do use positive language for campaigns and reinforce positive drinking messages. Do not preach to individuals.

- Do make them fun and engaging

- Do promote sensible drinking throughout the year

- Don’t just hand out leaflets. It is an important message so make an activity as engaging as possible. . - Raise the issue of alcohol consumption with individuals using some conversation starter tips in this toolkit

- Signpost to other resources that they could use to maintain their awareness of their own alcohol consumption, such as the drinks unit checker found on Change4Life Wales | Alcohol

Points- to remember:

- Remember to be creative and make your interaction appealing.

- Be sure that the links you provide are from a reliable source.

By getting involved in this campaign you will:

 Provide a key opportunity to influence the wellbeing of the population of

Hywel Dda.  Enable your organisation/community to take a proactive approach to

health.  Contribute to National health improvement goals

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Websites and contacts

Change for Life: Interactive website with tips, tools and advice on responsible drinking and ways to cut down Change4Life Wales | Alcohol

Hywel’s House: http://www.hywelddahb.wales.nhs.uk/healthy-wednesday

Drink Wise Wales: Contains practical tips for responsible drinking and downloadable drinks diary http://www.drinkwisewales.org.uk

Alcohol Concern Cymru: Sign up to their newsletter to keep abreast of alcohol related developments in Wales http://www.alcoholconcern.org.uk/ http://www.alcoholconcern.org.uk/projects/alcohol-concern-cymru

Public Health Wales Contains data and information on alcohol misuse in Wales http://www.wales.nhs.uk/sitesplus/888/page/71713

NHS choices: Contains useful information on drinking and alcohol, impact of alcohol on health, and tips to cut down alcohol. http://www.nhs.uk/Livewell/alcohol/Pages/Alcoholhome.aspx

Institute of Alcohol Studies: IAS

Drink Wise, Age Well: Drink Wise Age Well | Drink Wise Age Well

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Services and specialist support

DAN 24/7: Wales’ one stop shop for information, support and services relating to drugs or alcohol www.dan247.org.uk

Wales Drug and Alcohol helpline: 0808 808 2234

Corporate Health Standard: http://www.healthyworkingwales.com

Choices Young Persons Service: 01554 755779

DDAS: 03303 639 997

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Evaluation Form

Please use this to tell us what you did around Alcohol Awareness

Name: Organisation: County: Job Title:

1. How would you rate this toolkit and/or resources?

Excellent Good Fair Poor

2. Which resources did you use?

Yes No

‘Don’t let drink sneak up on’ you poster

‘What’s in your drink?’ poster

‘Don’t let drink sneak up on you’ A5 booklets

Alcohol Unit Wheels

Alcohol Unit Beakers

‘Dry January’ poster

‘Dry January’ leaflet

3. What campaign activities did you do?

Yes No

Poster(s) display How many displays? ......

Leaflets and alcohol unit wheels display How many displays? ......

Posted articles on the intranet and/or internet How many articles? ......

Article in newsletter

Information stand held How many stands? ......

Social networking employed

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4. How many people would you estimate were exposed to the campaign?

5. Select a handful of participants at random and ask them the following questions:

Question to ask Number Number No. saying saying saying yes no unsure

Are you aware of the ‘Don’t let drink sneak up on you – Have at least 2 alcohol-free days a week’ Alcohol Awareness Campaign that the organisation has run? If no, do not ask any more questions Having seen the campaign, do you understand why you should have at least 2 alcohol-free days a week? Do you think it’s important to have at least 2 alcohol-free days a week? Have you begun to think about changing the amount of alcohol you consume as a result?

6. Did you receive any comments or feedback on your campaign?

7. What other resources would you find helpful for running a future alcohol awareness campaign?

Return evaluation form to [email protected] or send to Liz Newbury-Davies at Hywel Dda Public Health Team, Public Health Wales, Building 1, PO Box 108, St David's Park, Jobswell Road, Carmarthen, SA31 3WY

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Produced by Hywel Dda Public Health Team, October 2015

This Toolkit has been adapted by Hywel Dda Public Health Team from the original developed by Cardiff and Vale Public Health Team using the toolkit developed in 2012 by Lee Parry-Williams, Helen Tunster and Josef Prygodzicz on behalf of Public Health Wales in partnership with Alcohol Concern Cymru.

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