Leicester Joint Strategic Needs Assessment (JSNA). Health and social care needs associated with alcohol use, 2016.
Alcohol use is responsible for 10% of the UK burden of disease and death, making it the third biggest lifestyle risk factor after smoking and obesity.
The impact of alcohol misuse is not confined to health outcomes. The social consequences of alcohol misuse, particularly in relation to crime, anti-social behaviour, domestic violence, road traffic accidents, and fires are significant.
*New, national safe drinking guidelines have only recently been released. Analyses undertaken in this version of the Alcohol section are based on safe drinking guidelines prior to 8th January 2016.
Who’s at risk and why?
In January 2016, the UK’s Chief Medical Officer issued new guidelines for safe levels of drinking. The alcohol limit for men has been lowered to be the same as for women. The guideline for both men and women is as follows:
You are safest not to drink regularly more than 14 units per week, to keep health risks from drinking alcohol to a low level:
- If you do drink as much as 14 units week, it is best to spread this evenly over 3 days or more.
- The risk of developing a range of illnesses (including, for example, cancers of the mouth, throat and breast) increases with any amount you drink on a regular basis.
- If you wish to cut down the amount you’re drinking, a good way to help achieve this is to have several drink-free days each week.
National data suggest that men are more likely to drink heavily than women. 37% of men and 25% of women consume more alcohol than is recommended (for men 3-4 units per day, women 2-3 units per day), based on pre-8th January 2016 guidelines.
Higher risk drinkers (women drinking over 35 units/week, men drinking over 50 units/week) are at greater risk of developing a range of alcohol related health harms, such as high blood pressure, liver cirrhosis, irregular heartbeat, cancers of the mouth, neck and throat and breast cancer.
The most deprived fifth of the population of the country suffer two to three times greater loss of life attributable to alcohol; three to five times greater mortality due to alcohol-specific causes; and two to five times more admission to hospital because of alcohol, than the more affluent areas.
The level of need in the population
Local alcohol consumption data was collected in the Leicester Health and Wellbeing Survey in 2015 and this showed that Leicester has a sizeable population (16+ years and over) of non-drinkers, at 50% of the population. Highest levels of non-drinkers are found in Asian ethnic groups (74%), followed by Black ethnic groups (67%), Mixed groups (40%) and lowest in White groups (31%). More women than men are non-drinkers and men have higher drinking levels than women, with around 7% of men and 3% of women drinking above the recommended weekly units. White population groups have the highest levels of drinking above the recommended daily levels (7%), with similar levels in Asian, Black and Mixed ethnic groups (2%).
Alcohol-related hospital admissions have fallen in Leicester over the past 5 years. However, rates are significantly higher for men in Leicester than men in England (2013/14). In women, alcohol-specific (directly caused by alcohol) hospital admission rates are significantly lower than in England and alcohol-related hospital admissions are similar.
Overall rates of alcohol-related mortality (Leicester 66.1, England 45.3 per 100,000), alcohol-specific mortality (Leicester 19.7, England 11.9 per 100,000) and mortality from chronic liver disease (Leicester 17.6, England 11.7 per 100,000) are all significantly worse than the national rate. Rates are worse in men than women (mortality rates for women are similar to the national average).
There were 133 deaths from chronic liver disease in Leicester between 2011 and 2013, of which nearly 75% were in men. This equates to a significantly higher mortality rate than nationally (17.6 deaths per 100,000 in Leicester, compared with 11.7 deaths per 100,000 in England). Mortality rates from chronic liver disease in Leicester have been rising, from 14.9 deaths per 100,000 (2006-2008) to 17.6 deaths per 100,000 (2011-2013).
In Leicester there has been a continued reduction in the level of alcohol-related recorded crime since 2008/09. However, the rates of alcohol-related violent crime, although falling, remain higher than the national average.
Current services in relation to need
Services in Leicester are commissioned in line with national guidance and good practice. Local alcohol interventions range from primary prevention/awareness raising to residential rehabilitation services and include awareness raising campaigns, brief interventions delivered by a healthcare professional, and a range of treatment services which include:
- Community-based integrated drug and alcohol services – these range from psychosocial interventions through to community-based detoxification.
- Specialist services supporting people in contact with the criminal justice system (from arrest through prison services and into probation services).
- The Anchor Centre – supports treatment resistant, entrenched drinkers who are often street drinkers as well.
- Young people’s services – specialist integrated drug and alcohol services. These provide support for young people and their families.
- Inpatient detoxification services.
- Residential rehabilitation services – support maintenance of recovery for people who have completed detoxification.
- Housing-related support – for people in recovery. This includes accommodation and ‘floating’ support (that is, workers who support clients in their own tenancy).
- Project Intercept – a specialist project in the area of dual diagnosis (mental ill health and alcohol/drug ill health).
Self-referral rates are 30% in Leicester, compared with 45% nationally. The largest referral routes are self-referral and via GPs. Referrals from GPs stand at 29%, compared with 20% nationally. Referrals via the Criminal Justice System are also higher locally than nationally (18% locally, compared with 8% nationally).
Projected service use and outcomes in 3-5 years and 5-10 years
The 16 years and over population of Leicester City is predicted to increase to 289,000 by 2030. This may mean a rise to 56,046 increasing risk drinkers by 2030 (from 51,423 in 2015) and a rise in high risk drinkers from 17,306 in 2015 to 18,862 in 2030.
If we assume that there is no change in the proportion of people drinking at the specified risk levels, then we can expect to see a rise in hospital admissions and death rates associated with alcohol consumption and these projections are detailed in the full section for download below.
Unmet needs and service gaps
The Leicester Health and Wellbeing Survey 2015 showed variation in knowledge regarding alcohol units between different groups:
- 33% of respondents had not heard of alcohol units.
- Certain cultural/religious groups were less likely to have heard of units (these are the same groups who are less likely to drink, including Hindus, Muslims, Sikhs and Black and Minority Ethnic Groups [BME]).
- Women were more accurate than men when asked about the official recommended maximum number of units they can drink per day (50% of women got this correct, compared with 41% of men).
Recommendations for consideration by commissioners
Recommendations in this section including ensuring treatment services are designed around the needs of the whole populaton at risk, while considering equity issues; targeting known priority groups and identifying additional such groups; highlighting the need for whole population alcohol misuse prevention work and ensuring such are commissioned; enhancing provision of low-level alcohol problem identification and interventions across health and social care; ensuring integrated and effective referral pathways between prevention, treatment and aftercare services; ensuring robust referral pathways between services for dual diagnosis clients; and continuing to provide for change resistant drinkers.
- Local alcohol profiles
- Drug and alcohol JSNA
- Leicester health and wellbeing survey 2015
- JSNA support pack for drug and alcohol abuse