ALCOHOL MISUSE

Tackling The causes and effecTs of alcohol misuse

Tackling The causes and effecTs of alcohol misuse‘investing in our nation’s future: The first 100 days of the next government’ was launched last year by the local government association (lga). it set out the challenges any new government will face in may 2015 and provided a local government offer on how to help them deal with the most pressing issues. The transfer of public health responsibilities from the NHS to local government and Public Health England (PHE) represents a unique opportunity to set out a local approach to tackling alcohol misuse.

We are calling on Government to help people live healthier lives and tackle the harm caused by excessive drinking and alcohol dependence by:

• reinvestingafifthof existingalcoholdutyin preventative measures

• givingcouncilsthepowertotakepublichealthissuesintoaccountwhenmakinglicensing decisions

• supportinglicensingandtradingstandards departments to better tackle the black market in alcohol.

We believe that health and crime reduction areimportantissuesforthepeopleweserveand that linking the taxes and duty they pay tospendingontheseissueswillbewelcome.

Additionalresourceswouldenablelocalcouncilstorespondtothespecifichealthand social care needs oftheir communities in waysthattheyknowwillbeeffective.

By implementing the range of policies outlinedinour100daysdocumentwewillsave £11 billion on the cost of the public sectorandempowerlocalcommunitiestohavearealsayintheirownfuture.

The food and drink manufacturing industry is the single largest manufacturing sector intheUK,withaturnoverof £92billion.The industry employs just under 400,000 workers.Alcoholandthewiderhospitalityindustrymakeanextremelysignificantcontribution to the national and local economies through bars, pubs, clubs and restaurants. For many people, moderate drinkingisawaytorelaxandenjoytheirleisuretimewithoutcausingimmediateharm either to themselves or to others.

However,thereisalsoaclearbodyof evidence demonstrating that drinking habits are harming the nation's health aswellascontributingtoproblemsonthestreetsof townsandcities.TheNHS recommends that men should not regularly drink more than three to four unitsof alcoholadayandwomenshouldnotregularlydrinkmorethantwotothree units a day. More than nine million people in England drink more than these recommended limits. This puts their long-termhealthatriskaswellasmakingthemmore likely to be involved in crime, violence anddisruptivebehaviourwhichcanthreatenthenight-timeeconomyintownsand cities, including the livelihood of those involved in the food and drink industry. Itisthesubstantialminoritywhodrinktoexcessandaredependentonalcoholwithwhichlocalcouncilsareconcerned.

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Thereasonswhypeoplemisuseandbecome dependent on alcohol are highly complex – an approach to reducing this misuse and mitigating its impact on society needs to be coordinated across public health, the NHS, the police, enforcement agenciesandplanning,workingwiththedrinks industry. As community leaders, localcouncilsarewellplacedtoleadsuchan approach.

The background• Alcoholmisuseisestimatedtocost£21

billion annually in healthcare, crime and lost productivity.1

• Alcoholis45percentcheaperthanitwasin1980.2

• AlcoholconsumptionintheUKincreasedbyninepercentintheUKbetween1980and2009.AcrosstheOECDinthesameperiod, it fell by nine per cent3.

• Thereisincreasingevidenceof thedamage caused by drinking during pregnancy – foetal alcohol syndrome is a preventable cause of infant mortality andtheleadingknowncauseof intellectual disability.4

• Alcoholcanharmdevelopingteenagebrains and hold back educational attainment.Researchshowsthattheearlier a child starts drinking, the higher their chances of developing alcohol abuse or dependence in their teenage yearsandadultlife–childrenwhodrinkbeforetheageof15aremostsusceptibleto alcohol misuse in later life.5

• Alcoholistheleadingriskfactorfordeathsamongmenandwomenaged 35-44yearsintheUK.6

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• InEnglandin2012,21,485deathsweredeterminedasbeingwhollyorpartiallydue to alcohol consumption7.

• 24percentof menand18percentof womenhaveanestimatedweeklyconsumption of more than the recommendedlevels,includingfivepercentof menandfourpercentof womenwhoseconsumptionputsthemintheNHS higher risk category.8

• Over17millionworkingdaysarelosteach year due to the effects of alcohol.9

• Onatypicalday,some10,000individualsintheUKseekhelpfortheirownorsomeone else’s drinking problem.10

• Onepercentof 11-yearoldsand25percentof 15-yearoldshavedrunkalcoholinthelastweek.11

• Betweenfiveand10percentofbothboysandgirlsaged14-15aredrinkingmorethan the recommended levels for adults.12

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• Peoplemaybedrinkinglessoverallthantheywerefiveyearsagobutfiguresarestillupfrom2000andthereisstillatrend of heavy episodic drinking among youngergroups,andoverhalf (52percent)of thosewhosaytheydrinkonfiveormoredaysintheweekareaged45and over.13

• Salesof illegalalcoholhaverisenfivefoldsince2009.Counterfeitalcoholnowaccountsfor73percentof allinvestigations by UK trading standards authorities(upfrom51percentin2009/10).Toxicandindustrialsolventsinfakespirits,whicharepackagedtoresemblewell-knownbrandsandsoldmuch more cheaply can cause death and blindness.14

did you know – alcohol and health?• Alcoholisacausalfactorinmore

than 60 medical conditions, including: mouth, throat, stomach, liver and breast cancers; high blood pressure, cirrhosis of the liver; and depression. Alcohol dependence and addiction is a serious mental health issue.

• Thereareanestimated1.6millionpeopledependent on alcohol in England but only 6.4 per cent of dependent drinkers access treatment.15

• In2011/12therewere1.2millionalcoholrelated hospital admissions, representing a35percentincreasesince2002/3.Of thoseadmissions49,456wereforliverdisease,whichistheonlymajorcauseof mortality and morbidity on the increase inEnglandwhilstdecreasinginotherEuropean countries.16

• Olderpeoplebetweentheagesof 60and 74 admitted to hospitals in England withmentalandbehaviouraldisordersassociatedwithalcoholusehasrisenbyover50percentmorethaninthe15-59agegroupoverthepast10years(a94percentincreaseinthe15-59agegroupfrom27,477to53,258anda150percentincreaseinthe60-74agegroupfrom3,247to8,120).17

• Peoplewithsevereandenduringmentalillness are three times more likely to be alcohol dependent than the rest of the population.18

• Morethanhalf (54percent)of studentsadmit they still consume at least double thedailyunitguidelineswhendrinkingsocially and almost a third (30 per cent) have blacked out or lost their memory due to drinking too much.19

• Childrentooareimpactedbyalcoholwithanestimated2.6millionlivingwithparentswhoaredrinkinghazardouslyand705,000livingwithdependentdrinkers.20

did you know – alcohol and crime?Alcohol affects not only the health andwellbeingof peoplewhomisuseitandtheirfamilies.Thereisawealthof information indicating a strong link betweenalcoholuseandcriminalanddisorderlybehaviour,includingroadtrafficinjuries and deaths, domestic violence and towncentreviolence.

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Thismakesitanissueforthewholecommunity,needingacommunity-wideresponse.

• 9,990peoplewerecasualtiesof drink-drivingaccidentsintheUKin2011including280whodiedand1,290whosuffered serious injury.21

• 47percentof violentcrimeisalcoholrelated.22Peoplewho‘pre-load’withalcohol, drinking before they go out forthenight,are2.5timesmorelikely to be involved in violence as a victim or an offender.23

• Offenderswerebelievedbyvictims to be under the influence of alcohol in nearly half of all incidents of domestic violence.24

• Alcoholplaysapartin25-33percent of knowncasesof childabuse.25

The cost of alcohol misuse, dependence and harm• Alcohol-relatedharmcosttheNHSinEngland£3.5billionin2011/12.26

• Alcohol-relatedcrimecost£11billionperyearinEngland(2010/11figures–thelatest available).27

• Lostproductivityduetoalcoholcosts the UK £7.3 billion a year.28

• In2011,therewere167,764prescriptionitems for drugs for the treatment of alcohol dependency in England,29 costing£2.49million.Thisisanincreaseof 3.3percentonthe2010figureandanincreaseof 45percentonthe2003figure.

• AlcoholfraudcoststheUKaround£1.3 billion a year in lost revenue to the Treasury.30 It also impacts adversely on the legitimate drinks industry.

• Forevery£1investedinspecialistalcoholtreatment,£5issavedonhealth,welfareand crime costs.31

• MisuseanddependenceonalcoholcostsEnglandover£21billionperyearinhealthcare, crime and lost productivity.32

This call for action from the LGA has brilliantly captured the current burden of alcohol harm in this country and the opportunity for properly resourced local initiatives to reduce it. There will always be areas where national policies will be most efficient and effective, such as setting a minimum unit price, and others, such as tackling the local night-time economy, where local government is best placed to act.

Let's work together to make sure there is coordinated national and local action for evidence-based policies to make our health better and our streets safer."

Prof Sir Ian Gilmore, Honorary Consultant Physician at the Royal Liverpool University Hospital and previous President of the Royal College of Physicians

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Private and external costs and benefits of alcohol use/misuse

Source:CabinetOfficeStrategyUnit,'Alcoholmisuse:Howmuchdoesitcost?': http://sia.dfc.unifi.it/costi%20uk.pdf

Costs

Benefits

Private external

loss of quality of life

Pain and suffering of family

and friends

morbidity of drinkers

Pain and suffering of misusers TreatmentPremature deaths

lawyers' fees Victims of crime or motor accidents

social 'lubrication'health benefits

Reduced employment

absenteeism enforcement

drinkers' spending on alcohol

increased insurance premiums

for non-misusers

Private insurance policies

Reduced productive efficiency

Private medical expenditure

drinkers' pleasure social capital social networks

Prevention

TheCabinetOfficeStrategyUnithasproducedadiagramthatsummarisesthecostsandbenefitsof alcoholuse/misuse,whichclearlydemonstratesthepreponderanceof negative impacts.

Tackling alcohol misuse – a local approachTheChief Executiveof NHSEnglandhasrecommended a “devo-max” approach to empoweringlocalcouncilsandelectedmayors in England to make local decisions on fast food, alcohol, tobacco and other public health-related policy and regulatory decisions, going further and faster than nationalstatutoryframeworkswherethereis local democratic support for doing so.

“…[T]he future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.”

“If the nation fails to get serious about prevention then recent progress in healthy life expectancies will stall, health inequalities will widen, and our ability to fund beneficial new treatments will be crowded-out by the need to spend billions of pounds on wholly avoidable illness.”

The NHS Five Year Forward View, October 2014

Thereisnowlessthansixmonthsuntilthecountryvotesforanewgovernment–onethatwilldeterminethefutureof ournation until the end of the decade and beyond.LaunchedinJulyatthe2014LGAconference,‘Investinginournation’sfuture:Thefirst100daysof thenextgovernment’33 sets out local government’s offeronwhatthenewgovernmentwillneedtodo–initsfirst100days–tosecure a bright future for the people of this country.

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TheLGAiscallingforanewrelationshipwithcentralgovernmentunderpinnedbythree key principles:

• moredevolutionof powertoelectedcouncillors

• communitybudgetswouldbethepreferred mechanism of delivery for government departments

• financialsettlementsshouldbetiedtothelifetime of the parliament for all the public sector.

We are calling on Government to help people live healthier lives and tackle the harm caused by excessive drinking and alcoholdependencebyreinvestingafifthof existing alcohol duty in preventative measures and supporting licensing and trading standards departments to better tackle the black market in alcohol. We believe that health and crime reduction areimportantissuesforthepeopleweserve and that linking the taxes and duty theypaytospendingontheseissueswillbewelcome.Additionalresourceswouldenable local councils to respond to the specifichealthandsocialcareneedsof theircommunitiesinwaysthattheyknowwillbeeffective.

“Alcohol crime often overlaps with health issues so it is important to work closely with local health and wellbeing boards and other health professionals to identify the scale of the problem and take action to reduce misuse.”

Tony Lloyd, Police and Crime Commissioner for Greater Manchester and Chairman of the Association of Police and Crime Commissioners34

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alcohol duty receipts Dutyonspirits,wine,beerandciderin2012/13raised£10.1billionfortheExchequer.

Thegraphbelowshowsalcoholreceiptsandthepercentageof GDPoverthelastfiveyears.Receiptscontinuetoincrease,andin2013/14therewasanannualincreaseof 2.3percent;dutyratechangesarethemainreasonfortheincrease.Receiptsasapercentageof GDPhaveslightlydeclinedoverthepasttwoyears,butaregenerallystable.

Source:HMRevenueandCustoms,MonthlyandAnnualHistoricalRecord,21November2014: www.gov.uk/government/uploads/system/uploads/attachment_data/file/376863/20141112_Octreceiptsbulletin.pdf

£bn

12.0

10.0

8.0

6.0

4.0

2.0

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Percentageof GDPCashrevenue

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What needs to be done?TheGovernment’s2012AlcoholStrategyidentifiesanumberof evidence-basedcomponents that need to be implemented to reduce alcohol-related harm. These range from environmental approaches acting on the promotion and supply of alcohol, to short health interventions aimed atgroupsof peoplewhoareatriskof alcohol health harm and more intensive specialisttreatmentforthosewhosealcoholdependency is damaging their health and wellbeing.

AccordingtoAlcoholConcernthemosteffective strategies to reduce alcohol-related harm from a public health perspective include, in rank order, price increases, restrictions on the physical availability of alcohol, drink-driving counter measures,brief interventionswithat-riskdrinkers,andtreatmentof drinkerswithalcohol dependence.

TheNHSagreedwiththeLGAthat“Englishmayors and local authorities should be grantedenhancedpowerstoallowlocaldemocratic decisions on public health policy that go further and faster than prevailingnationallaw–onalcohol,fastfood, tobacco and other issues that affect physical and mental health.”

• Reducingbyatenththeworkingdayslosttoalcoholmisusealonewouldsave £770 million.

• Reducingalcohol-relatedharmbyjustonetenthwouldsavetheNHS£350 million each year.

• Reducingalcoholfraudbyonetenththroughadditionalidentificationandenforcementwouldsave£130million a year.

• Reducingthenumberof alcohol-relateddeathswouldsaveover1,500lives each year – the monetary value is incalculable.

local government’s role in tackling alcohol misuseLocalcouncils’responsibilitiesforhealthandwellbeingboards,socialcare,planningandhousingstrategyaswellas public health, environmental health, licensing and trading standards put them attheheartof thewebof influencesneeded to tackle this complex issue.

It is generally agreed that misuse of and dependency on alcohol and their links tomentalillhealth,familybreakdown,homelessness and crime have complex causes and consequences.

• Thereisnosinglesolutiontotacklingthisissue.

• Acoordinated,multi-strandedapproachis needed, tailored to the character of each community.

• Localcouncilsarebestplacedtoleadaconcerted attempt to tackle the problem since they have a leading role to play in all the evidence-based approaches identifiedintheprevioussection.

UndertheHealthandSocialCareAct2012,upper tier and unitary authorities became responsible for improving the health of their population. The responsibility for public health transferred from the NHS to localauthoritieson1April2013.Theyalsohost the Health and Wellbeing Boards, bringing together the NHS, social care and community spokespeople to develop an overarching strategy for the health and wellbeingof thearea.

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Localcouncils’socialservicesdepartmentsarekeypartnersalongwiththe NHS, the courts and police and in drug and alcohol and community mental health teams.

LocalauthoritiesarealsokeyplayersinlocalCrimeandDisorderReductionPartnerships(CDRP),workingtoreduceoffending behaviour and mitigate the effects of crime.

Businesses, organisations and individuals whowanttosellorsupplyalcoholinEngland and Wales must have a licence or other authorisation from a licensing authority – this is usually a local council. The trading standards teams in local councils have an important role to play in ensuring that licenses are adhered to and that they meet the objectives of protecting children from harm, public safety and preventing crime and disorder.

The Government’s alcohol strategy pointed out that alongside, their licensing powers,localauthorities,incollaborationwiththeirpartners,caninfluencealcoholconsumptionthroughenforcinglawsonunderage sales, promotion and advising people about sensible drinking and by commissioning alcohol prevention and specialist treatment. The strategy said that locally-ledandownedapproacheswerethe key to tackling the issue.

Illicitalcohol,whethernon-dutypaidorcounterfeitisknowntobeaseriousnational problem, but often tends to belocalisedwithspecificillicittradersinvolved.35This places local authority trading standards and licensing teams on thefrontlinewhenitcomestodetectingandshuttingdowndistributorsandretailers of illicit alcohol.

What could local councils do with more resources? Councilshave,foranumberof years,beenimplementing strategies to reduce levels of excessive drinking, both from the health and from the crime perspective. For example, weparticipateinmulti-agencyDrugandAlcoholTeamsineveryarea,workingwithpeoplewhoaredependentonalcohol.WeplayanactivepartinCrimeandDisorderReduction Partnerships. We support the PurpleFlaginitiative,workingwiththefoodand drink industry, the police, the NHS and community and voluntary organisations tomaketowncentresmorefamily-friendlyin the evening and thereby enhance the night-timeeconomy.Ourlicensingteamsinspect on and off licensed premises and enforce regulations on under age sales. More recently, some councils have been workingwiththelocaldrinkindustrytoreduce the number of outlets selling high and super-strength alcohol. And public health teams have begun to map outlets in theirareawherealcoholissoldandrelatethis to prevelance of excessive drinking, locationswherechildrenandyoungpeoplegather and alcohol-related health conditions to contribute an additional dimension to our planning strategies.

However,muchofthe£2.8billionpublichealth budget (see graph opposite) is taken upwithprovidingtheessentialservicesweare legally required to provide, such as sexual healthservices(whichtakeup25percentof the budget), the NHS Healthcheck, the nationalChildMeasurementProgrammeandourhealthprotectionwork.Drugandalcoholservices (30 per cent) are predominantly demand led, leaving little scope to do the moreproactivepreventionworkthatcouldbring about more rapid changes.

general fund Revenue accounts Budget estimate 2014/15

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• Wecouldundertakemuchmorework,for example, in schools and colleges and other settings to ensure that young people understand the impact of alcohol misuse and receive help and counselling at an early stage if they need it.

• Wecouldinvestmoreinsupportingourtownandcitycentres,forexamplethrough the Purple Flag scheme, to beplaceswherepeoplecandrinkmoderatelyandsensiblyandwhichhave a thriving family-friendly night-time environment.

• Wecoulddevelopmoreteamstoworkwithfamiliesatrisktomitigatetheeffectsof their drinking members and support thewholefamilyintacklingtheproblemsandstayingtogetherwithoutharm.

• WecouldbuildontheworknowdonebyFamily Nurse Partnerships and children’s centres to break intergeneration paths to dependency and bring these services to amuchwidersectionof thepopulation.

• WecouldputmoreresourcesintofollowingupandsupportingpeopleidentifiedintheirannualHealthCheckas drinking more than the recommended amounts.

• Wecouldworkmorewiththecourtsandthepolicetodivertalcoholmisuserswithmentalhealthproblemsawayfromthecriminal justice system to reduce the time the police currently have to spend as proxy social care and mental health workersandgivethemmoretimeformainstream policing.

• WecouldworkmorewiththeNHSlocally to develop integrated treatment settingsforpeoplewithclustersof interdependent problems.

• WecouldcreateliaisonpoststoworkwithpeoplewhoreporttoAccidentandEmergencydepartmentswithdrink-related injuries and illnesses, to break a downwardspiralintoillness,dependencyand/orcrime.

• Wecoulddevelopwithourpartnersholisticcareandwecouldfurtherdevelop support packages and proper long-termcareforthosewhoneedit,includingpeoplewhoarehomelessandsleeping rough because of alcohol and drug dependence.

• Wecoulddevelopbetterservicesto tackle excessive drinking among offenders and improve their health – at the moment, commissioning of these services is fragmented and needs investment.

• Wecouldputmoreresourcesintoourlicensing and trading standards teams to workwithretailoutlets,pubsandclubsto reduce and control the availability of alcohol to vulnerable people and to enforcethelawsonunder-agedrinkingandsellingdrinktopeoplewhoarealready drunk.

• Wecouldworkmorecloselywiththepolice,customs’officersandprivatecompaniestoidentifyandcrackdownon counterfeit alcohol and non-duty paid activity.

• Wecoulddomoretodevelopandshare the evidence base for effective interventionssothatwecouldtargetourworkmoreeffectively.

• Overall,wecouldcommissionservicesfor the longer term to help make them sustainable and give better value for our investment of the public pound.36

Below is a list of some of the activities we could develop, expand and strengthen with additional resources

BrigHton anD Hove – a CoorDinateD aPProaCHAcasestudyexampleof how,withsignificantlymoreresources,localcouncilsmightaddress alcohol misuse through the discharge of their public health and related duties isprovidedbyBrightonandHoveCityCouncil.

Overthelastseveralyears,over-consumptionof alcoholhasbeenanincreasingproblem in the city. So much so, that the council and local partners decided to prioritise developing a coordinated approach to the issue.

The estimated local annual health, social and crime costs from alcohol are £107 million. Ontheotherhand,theannualeconomicturnoverfromitssaleisestimatedat£329.Thecouncilwasveryawareof thebenefitstotheeconomyandemploymentfromalcoholproductionandsales.Itwantedtogetthebalancerightbetweentheeconomicbenefitsto the city of alcohol and limiting the serious harm it causes. With this in mind, it set up a multi-agencyAlcoholProgrammeBoardwithrepresentativesof publichealth,theNHS,the police, the council’s licensing department and the drinks industry. The latter included representativesfromoff andonsalesandtheeventsprogrammeforthecitywasalsotaken into account.

The move of public health to local government has made it easier for joint commissioningwithotherdepartmentstotakeplace.Forexample,the‘Equinox’servicewhichworkswithstreetdrinkersisjointlycommissionedwiththehousingdepartment.

In a pioneering approach to the council’s licensing function, public health analysts have mapped the presence, use and impact of alcohol around the city in a Public Health LicensingFramework.Alllicenseapplicationsareseenandcommentedonbythedirectorof publichealth,whousestheFrameworktoassessrisk.

ThePublicHealthteamcommissionsa‘recoveringhealth’trainerworkingwiththecouncil’s environmental health team to support people coming out of drug and alcohol treatment,forexampleinlookingforworkoreducation.

Thecouncilhaslaunchedacampaign,‘SensibleonStrength’toreducethenumberof off-salesoutletssellinghighandsuperstrengthalcohol.Over70off-licencesinBrightonand Hove have signed the agreement to date.

Thepublichealthteam,withthesupportof thecouncil’sschoolsteamhaspilotedaparentalalcoholcontract,basedontheSwedish‘Effekt’model,whereparentsmakeapromisenottogivealcoholtotheirchildrenunder18.Thereisevidencethatintroducingyoung people to alcohol early does not teach them to drink moderately and is more likely to lead to drinking problems at a later age.

Thecouncilwouldliketodomuchmoretotacklethecausesandconsequencesof excessivedrinkingandtosupportthosewhoareharmedbecauseof it.

Kathy Caley LeadCommissioner,alcoholandsubstancemisuse [email protected]

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1. AlcoholConcernMakingsenseof alcoholwww.alcoholconcern.org.uk/wp-content/uploads/2014/09/Summary-of-alcohol-statistics.pdf


3. AlcoholConcernStatisticsonalcoholwww.alcoholconcern.org.uk/help-and-advice/statistics-on-alcohol/

4. SeetheDrinkawarewebsiteforfurtherinformation:www.drinkaware.co.uk/check-the-facts/health-effects-of-alcohol/fertility-and-pregnancy/foetal-alcohol-syndrome

5. SeetheDrinkawarewebsiteforfurtherinformation:www.drinkaware.co.uk/check-the-facts/health-effects-of-alcohol/your-child-or-teenagers-health/your-child-or-teenagers-health

6. Public Health England, Alcohol E-shot, Issue36,October2014:us2.campaign-archive1.com/?u=86f2d89238f102b701fff258f&id=01292013b7

7. LocalAlcoholProfilesforEngland:April2014annualdataupdate2014www.gov.uk/government/statistics/local-alcohol-profiles-for-england-april-2014-annual-data-update

8. HealthandSocialCareInformationCentre(HSCIC),2014,StatisticsonAlcoholEngland,2013:www.hscic.gov.uk/catalogue/PUB15483/alc-eng-2014-rep.pdf

9. Instituteof AlcoholStudieswebsite.‘Alcoholintheworkplace’factsheet.Availableat:www.ias.org.uk/Alcohol-knowledge-centre/Alcohol-in-the-workplace.aspx

10. Society for the Study of Addiction, TacklingAlcoholTogether:www.addiction-ssa.org/tat.htm

11. HSCIC,2014,StatisticsonAlcoholEngland,2013:www.hscic.gov.uk/catalogue/PUB15483/alc-eng-2014-rep.pdf

12.Society for the Study of Addiction, Tackling Alcohol Together: www.addiction-ssa.org/tat.htm

13. OfficeforNationalStatistics(ONS)Chapter2-Drinking(GeneralLifestyleSurveyOverview-areportonthe2011GeneralLifestyleSurvey)www.ons.gov.uk/ons/rel/ghs/general-lifestyle-survey/2011/rpt-chapter-2.html

14. Guardian,10June2014,‘Counterfeittraders fuelling demand for cheap and potentiallydangerousbooze’:www.theguardian.com/society/2014/jun/10/counterfeit-traders-demand-cheap-booze

15.National Treatment Agency for Substance Misuse Alcohol Treatment inEngland2011-12www.nta.nhs.uk/uploads/alcoholcommentary2013final.pdf

16. Public Health England Alcohol Treatment inEngland2012-13www.nta.nhs.uk/uploads/alcohol2012-13.pdf


18.AlcoholConcernMakingsenseof alcoholwww.alcoholconcern.org.uk/wp-content/uploads/2014/09/Summary-of-alcohol-statistics.pdf

notes

19.Drinkaware2010:www.drinkaware.co.uk/about-us/press-office/student-drinkers-are-more-responsible-than-young-adult-workers

20.AlcoholConcernMakingsenseof alcoholwww.alcoholconcern.org.uk/wp-content/uploads/2014/09/Summary-of-alcohol-statistics.pdf

21.DepartmentforTransportReportedRoadCasualtiesinGreatBritain:2011AnnualReportwww.gov.uk/government/uploads/system/uploads/attachment_data/file/9276/rrcgb2011-03.pdf

22.CrimeSurveyof England&Wales2011/12www.ons.gov.uk/ons/guide-method/method-quality/specific/crime-statistics-methodology/2011-12-crime-survey-for-england-and-wales-technical-report-volume-one.pdf

23.This and the other crime statistics quoted here arereferencedbytheAssociationof Chief PoliceOfficers(ACPO),InFocus:AlcoholHarm,pressreleaseissued18September2013:www.acpo.presscentre.com/Press-Releases/In-Focus-Alcohol-Harm-264.aspx

24.Government’salcoholstrategy–‘Safe.Sensible.Social’(2007)

25.AlcoholConcernandtheChildren’sSociety,2010,Sweptunderthecarpet:childrenaffectedbyparentalalcoholmisuse:www.alcohollearningcentre.org.uk/Topics/Browse/Children/?parent=4977&child=6336

26.PublicHealthEngland,2014,AlcoholtreatmentinEngland2012-13

27.HomeOfficeAlcoholstrategy2012www.gov.uk/government/publications/alcohol-strategy#_blank

28.JohnWoodhouseandPhilipWard(March2013),'Aminimumpriceforalcohol?',Houseof CommonsLibrary:www.parliament.uk/business/publications/research/briefing-papers/SN05021/alcohol-minimum-pricing

29.HSCIC,2014,StatisticsonAlcoholEngland,2013:www.hscic.gov.uk/article/2021/Website-Search?productid=7172&q=alco

30. HMRevenue&Customs,Measuringtaxgaps2014edition:www.gov.uk/government/uploads/system/uploads/attachment_data/file/364009/4382_Measuring_Tax_Gaps_2014_IW_v4B_accessible_20141014.pdf

31. Public Health England Alcohol and drugs prevention,treatmentandrecovery:whyinvest?www.nta.nhs.uk/uploads/why-invest-2014-alcohol-and-drugs.pdf

32.HomeOfficeAlcoholstrategy2012www.gov.uk/government/publications/alcohol-strategy#_blank

33. LGAInvestinginournation’sfuture:Thefirst100daysof thenextgovernment2014100days.b-creativedesign.co.uk/wp-content/uploads/2014/07/Investing-100days-template-web.pdf

34. ACPO,opcit.

35.LGA,2014,IllicitAlcoholSurvey–NationalResults:www.local.gov.uk/documents/10180/11701/Illicit+Alcohol+Survey_Final+Report.pdf/e0a3b499-2bc7-4db7-bc99-387ceed0065b

36. PHEandAssociationof Directorsof PublicHealth(2014)Reviewof alcoholcommissioning:www.nta.nhs.uk/uploads/review-of-drug-and-alcohol-commissioning-2014.pdf providesnumerousexamplesof wheremoreworkisneeded to tackle the problem.

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