April 2017 Alcohol ‘ A Whole Population Approach’ Insert Names here: Whole Population – What is covered? Trends in prevalence, affordability and availability Alcohol & ill health (alcohol-related deaths) Attitudes & Values Social norms Societal costs Understanding alcohol units and guidance Drinking definitions Problematic Drinking Alcohol & ill health (wider impact) Stages of an Alcohol Brief Intervention (ABI) Screening Attitudes & Values? Alcohol Consumption UK (1900-2010) Litres of pure alcohol consumption per capita in the UK, 1900-2010 11 10 Beer Cider Wine Spirits RTDs 9 8 7 6 5 4 3 Litres of pure alcohol per head per alcohol pure of Litres 2 1 0 1900 1905 1910 1915 1920 1925 1930 1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 Year Consumption – Sales – Impacts • UK has high levels of alcohol consumption in context of Europe. Scotland purchases 20% more alcohol than the rest of the UK (that gap once being as high as 25%) with an increase in sales in 2014-2015 MESAS data (2016) • In 2015 alcohol off-sales account for 74% of all sales in Scotland. Average price for off-sales alcohol is £0.52 per unit (with more than half being sold under this. Average price for on-sales is £1.74 per unit. MESAS (2016) • Mismatch between sales and reported consumption (from Scottish Health Survey) so highly likely that actual consumption is under-reported • Cost to Scotland for alcohol-related issues estimated at £3.6 billion* p.a. Costs to Aberdeen estimated to be around £120 million p.a. (2010, based on 2007 data analysis) • Costs calculated incorporate health, lost economic productivity, crime and anti-social behaviour, accidents and premature deaths (taking into account wider effects of alcohol) Hazardous / Harmful Men (SHS 2014) Hazardous / Harmful Women (SHS 2014) Alcohol & Older People Alcohol intake could cause problems due to: • Reduced liver metabolism • Lower ratio of body water to fat • Negative (multiple) medication interactions • Decrease in other activities • Cognitive impairments interfering with self monitoring (under-reporting) • Instability, falls and accidents/injuries • Poorer nutrition • Low mood/depression (80-84 age group has UK’s highest suicide rate) – alcohol a linked factor in self-harm and suicide Alcohol & Older People • RCGP estimate that between 6-7% of over 60 year olds with problems do not get the treatment they require • However, within this age group individuals more likely to have mild dependence – and generally more motivated than younger age groups to change behaviour Recommendations: • Evidence suggests not drinking more than 1.5 units per day • Focus on whole person and relationship between ageing and alcohol (including role of family/carers) • Use of SMAST-G screening tool • Mental and physical examination • Provision of brief interventions Affordability & Sales Scotland: Affordability increased 45% between 1980 and 2007 and only a small drop off since (MESAS 2012) In sum, sales follow affordability Graph from: ONS Real Households Disposable Income UK (2015) Alcohol Related Deaths UK Men 1994-2015 Alcohol Related Deaths UK Women 1994-2015 Alcohol Related Deaths UK in Context Health Scotland (MESAS) 2014 Alcohol Awareness Week (2008) Grampian The Usual Suspects ‘social norms’ survey with 1545 respondents • 95% aware of alcohol guidelines, with 26% (??) able to calculate units • Over-estimation of peer drinking 5.2 drinks to 7.9 drinks ‘estimated’ • 86% believed their alcohol consumption had no effect on work • 21% had reported being either late for or missing work • 27% reporting being subject to gossip or a loss of dignity • 41% experiencing memory loss • 48% experiencing regretful conversations or arguments • 16% had experienced anti-social behaviour, violence or theft • 32% experience of minor injuries • 2% had experience of a major accident • 19% experiencing regretful sex • 12% reported detriment to health • 46% under age of 35 with 20% of sample under age of 25 (students) A “Continental” style of drinking? • Wine drinking on steady decrease in France • Fall in consumption of wine is mirrored in other countries such as Spain and Italy • In France - at dinner, wine is now the third most popular drink behind tap and bottled water with other non-alcoholic drinks catching up • Change in policy France – higher value wines compared to cheap table wines • Proportion of people who never drink wine at all has doubled to 38% • Stronger enforcement of drink-driving rules in recent years – now must carry breathalyser kits in cars • Overall consumption down over last 50 yrs but rise of “beuverie express” in younger age groups Low Risk Drinking Guidelines? Units Exercise! Drinking Definitions: Hazardous Level of consumption Men & 14 > Units above the sensible limit Women: increasing the risk of harms Harmful Level of consumption Men: 50> Units causing actual damage to Women: 35> Units health and wellbeing Dependent Physical and High tolerance and psychological dependence presence of withdrawal present syndrome Binge Drinking More than double Could include any of recommended daily unit above as a regular intake and/or drinking to pattern of drinking get drunk (including problematic drinking) SHS Knowledge Attitudes & Motivations Education, Education, Education ! Nationally 23% of men and 17% of women drink hazardously / harmfully (SHS 2015) Only 20% of men and 11% of women can accurately describe sensible drinking guidance. Those in older age groups had poorer recall of limits (SHS KAM 2011) Only 1 in 6 (17%) of both sexes could accurately describe daily guidance and upper limits (SHS KAM 2011) Only 38% of both sexes could recall familiarity with keeping alcohol-free days each week (SHS KAM 2011) Thornley Model – Problem Drinking Health problems over time; physical, mental Excessive regular consumption Intoxication Dependence Accidents, Violence High tolerance, Criminality Withdrawal Syndrome A problem drinker falls within the perimeter of the circles. It is worth noting that problems, risks & harms can arise from intoxication alone. Health Issues – Body Map Exercise Body Map Exercise: Premature aging Medical Presentations Summary of Specific Health Risks Drinking above daily benchmarks: • Raises blood pressure, risk of coronary heart disease • Leads to incremental increase in risks of cancer (oral, breast, liver), liver disease • Risk of psychological/emotional problems/depression, dementia (early on-set) and detrimental to mental wellbeing overall • Increases risk of increased tolerance and dependency • Poorer sleep patterns • Increases calorific intake and resultant weight gain • Increases risky sexual health behaviours • Increases risk of hospital admission Alcohol & Hypertension • Regularly drinking alcohol progressively (dose dependent) increases the risk of developing hypertension • Drinking more than 3 alcohol drinks a day can increase the chance of developing hypertension in later life by up to 75% • Hypertension untreated significantly increases risk of stroke, heart disease and vascular dementia and chronic kidney disease • Most prevalent alcohol-related condition and most prevalent in over 35 age group • It is not the type but rather the volume of alcohol consumed that affects blood pressure • Alcohol is therefore one of the most preventable risk factors related to hypertension Alcohol & Cancer – Emerging Risks • Drinking alcohol, even within the limits of current advice on sensible drinking, may increase the risks of alcohol- attributable oral and pharyngeal cancers and cancer of the female breast • Drinking alcohol at levels higher than the guidelines for sensible consumption can increase the risk of cancer within the larynx, oesophagus, liver, colon and rectum • In 2010, alcohol was an attributable risk factor in approximately 7%, or 1948 new cases, of cancer in Scotland. Globally 21% of cancer deaths alcohol related • In the UK, 6% of breast cancer cases were directly attributable to alcohol consumption – 3,000 cases (2011-12) Dose/Response – Alcohol & Cancer Type Alcohol & Mental Wellbeing • Research shows alcohol misuse is related to the development of mental health problems – e.g. depression • Alcohol can actually increase stress and anxiety rather than reduce it through disturbing sleep, inducing feelings of lethargy and low mood and increasing anxiety in situations where someone would normally feel comfortable • Drinking often encourages risk-taking and is linked with self-harm and suicide (ideation and attempts) • It is common for people with a severe mental illness to also have alcohol problems. This may be due to issues around ‘self-medication’ Alcohol & Dementia • Emerging evidence shows that frequent drinking in earlier adulthood increases risk of developing early-onset dementia such as Alzheimer’s (before age 65)* • This can outweigh considerations regarding family history, use of other drug types and wider health conditions • Brain capacity naturally diminishes with age but in men who regularly drink alcohol – their brains appear between 1.5 to 5.7 years older than healthier peers • In individuals with severe alcohol problems – a type of alcohol-related dementia – ‘Wernicke-Korsakoff’s Syndrome’ can present. This is often termed alcohol- related brain damage (ARBD) • Partial recovery is possible with abstention from alcohol and a healthier diet (including vitamin B1 doses) Alcohol & Calorific Value Strong correlation between alcohol and weight gain and contributor towards obesity. Weight maintenance in adulthood also strongly associated with