Interesting things about alcohol in 2015/16 for alcohol awareness week

Interesting things about Alcohol in the last yearA set of slides for Alcohol Awareness week

Prevalence of drinking

Recorded alcohol per capita consumption in the United Kingdom, from 2000

20122011201020092008200720062005200420032002200120000

2

4

6

8

10

12

14

All types Beer WineSpirits Other alcoholic beverages

Litre

s of

pur

e al

coho

l

Source: Global Health Observatory data repository

In order to make the conversion into litres of pure alcohol, the alcohol content (% alcohol by volume) is considered to be as follows: Beer (barley beer 5%), Wine (grape wine 12%; must of grape 9%, vermouth 16%), Spirits (distilled spirits 40%; spirit-like 30%), and Other (sorghum, millet, maize beers 5%; cider 5%; fortified wine 17% and 18%; fermented wheat and fermented rice 9%; other fermented beverages 9%).

Share of total alcohol consumed by the 20% of the population who drink the most

France

Switzerl

and

Spain

New Zea

land

German

y

UK (Eng

land)

Irelan

d

Finlan

dKore

a

Canad

aJa

pan

United

Stat

es

Hunga

ry0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

63%

Source: Health at a Glance - Alcohol (OECD)

“Alcohol consumption is highly concentrated, as the large majority of alcohol is drunk by the 20% of the population who drink the most, with some variation across countries.”

Proportions of men and women in England drinking above the CMO low risk guideline of 14 units a week, by age

16-24 25-34 35-44 45-54 55-64 65-74 75-84 85+0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Male

More than 14, up to 21 units More than 21, up to 28 unitsMore than 28, up to 35 units More than 35, up to 50 unitsMore than 50 units

16-24 25-34 35-44 45-54 55-64 65-74 75-84 85+0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Female

More than 14, up to 21 units More than 21, up to 28 unitsMore than 28, up to 35 units More than 35, up to 50 unitsMore than 50 units

Source: Health Survey for England (2014)

Hazardous, harmful and dependent drinking in the past year by sex: 2000, 2007 and 2014

Hazardous drinking in men Harmful/mild dependence and probable dependence in men

Hazardous drinking in women Harmful/mild dependence and probable dependence in

women

0%

5%

10%

15%

20%

25%

30%

35%

40% 2000 2007 2014

Source: Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014

Self reported drinking behaviours of adults invited to Health Check

 Non-drinker  Trivial <1 units/day

 Light 1–2 units/day

 Moderate 3–6 units/day

 Heavy 7–9 units/day

 Very heavy >9 units/day

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

NHS Health Check No NHS Health Check

Source: The NHS Health Check in England: an evaluation of the first 4 years

n = 214,295 n = 1,464,729The NHS Health Check is a health check-up for adults in England aged 40-74. People in the age group, who don’t have a pre-existing condition, receive a letter from their GP or local authority inviting them for a NHS Health Check every five years.

AUDIT scores for older adult (50+ years) drinkers in UK

Lower

risk (

1-7)

Increa

sing r

isk (8

-15)

Higher

risk +

poss

ible d

epen

denc

e (16

+)0%

10%20%30%40%50%60%70%80%90% A profile of older drinkers in the UK today

▪ The vast majority (80%) of older drinkers in the areas we surveyed are lower risk drinkers, 17% are increasing risk drinkers, and 3% are higher risk drinkers.

▪ Amongst higher risk drinkers, 72% drink four or more times per week, while 58% typically drink 10 or more units a day.

▪ People who are LGBT, are not married, partnered, or cohabiting, live alone, and who have a longstanding illness or disability are more likely to be higher risk drinkers than those who are not.

n = 10,627

Source: Drink Wise, Age Well: Alcohol Use and the Over 50s in the UK

Frequent drinking (at least 5 days in last week) by income

Up to £9999

£10,000 up to £14,999

£15,000 up to £19,999

£20,000 up to £29,999

£30,000 up to £39,999

£40,000 or more

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20% Individuals with an annual income of £40,000 and over were more than twice as likely (18%) to be frequent drinkers compared with those with an annual income less than £10,000 (8%).

Almost 4 out of every 5 people (78%) in the highest income band (income of £40,000 or more) said they had drunk alcohol in the last week and alcohol consumption generally falls as income falls. Almost 3 in 10 (29%) people in the lowest income band classed themselves as teetotal (that is, they do not drink alcohol at all), compared with less than 1 in 10 (9%) for the highest income band.

Source: Adult Drinking Habits In Great Britain: 2014 (ONS)

Alcohol and the NHS

Those with the most problems with alcohol are more likely to use the NHS

Inpatient stay in the past quar-ter

Outpatient visit in the past quarter

Spoken with GP in the past 2 weeks

Spoken with GP in the past year

0%

5%

10%

15%

20%

25%

30%

35%

40%Non-drinker/low risk (0-7)Hazardous drinking (8-15)Harmful/ mild dependence (16-19)Probable dependence (20+)

Source: Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014

Number of attendances at A&E in England recorded as having social problems (including chronic alcoholism and homelessness)

2013-14 2014-150

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

39,50740,867 Please note:

During the period covered (2013-14 and 2014-15) not all NHS trusts have provided data submissions to A&E HES and data quality can be poor for some fields. 

Source: Accident and Emergency Attendances in England - 2014-15

Number of prescription items for the treatment of alcohol dependence dispensed in the community in England

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 20150

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

200,000

Prescribed in primary care Prescribed in NHS hospitals

Source: Statistics on Alcohol, England 2016 (HSCIC)

The cost and number of prescriptions of Disulfiram (to treat alcohol disorders) in England

Nov-11

Jan-1

2

Mar-12

May-12

Jul-1

2

Sep-12

Nov-12

Jan-1

3

Mar-13

May-13

Jul-1

3

Sep-13

Nov-13

Jan-1

4

Mar-14

May-14

Jul-1

4

Sep-14

Nov-14

Jan-1

5

Mar-15

May-15

Jul-1

5

Sep-15

Nov-15

£-

£20,000.00

£40,000.00

£60,000.00

£80,000.00

£100,000.00

£120,000.00

£140,000.00

£160,000.00

£180,000.00

-

1,000

2,000

3,000

4,000

5,000

6,000

Cost Items

Source: OpenPrescribing.net - https://openprescribing.net/chemical/0410010B0

Drink driving

Casualties in reported drink drive accidents: GB 1979 to 2014

1979

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

0

5,000

10,000

15,000

20,000

25,000

SlightSeriousFatal

Source: Reported road casualties in Great Britain, estimates involving illegal alcohol levels: 2015

The number of killed or seriously injured (KSI) casualties [where at least one driver was over the drink drive limit], which is 1,310 for 2014, is the lowest KSI total for reported drink drive accidents on record.

However the reduction in KSI casualties from the 2013 levels is not statistically significant.

Nevertheless, there is an ongoing downward trend, with falls in every year since 2002, barring 2011.

Positive response to question of whether you know anyone who does this…

Drive after taking Class A drugs

Drive after smoking cannabis

Drive when over the legal alcohol limit

Drive when unsure if over legal alcohol limit

Drive after drinking two pints

0% 5% 10% 15% 20% 25% 30% 35% 40%

6%

12%

19%

38%

38%

Source: THINK! Road Safety Biennial Survey

Drink DrivingWhile the vast majority of people agree that it is dangerous and unacceptable to drive when over the legal alcohol limit or when unsure, the level of agreement has fallen in 2015.

Disqualified from driving after being convicted of a drink or drug driving offence

2011 2012 2013 2014 20150

10,000

20,000

30,000

40,000

50,000

60,000

70,000

60,89058,652

53,81950,523

36,438

Source: FOI release: Number of individuals who have been disqualified from driving after a drink driving offence

Age profile of those disqualified from driving following a drink or drug driving offence 2011 to 2015

15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60 63 66 69 72 75 78 81 84 87 90 930

2,000

4,000

6,000

8,000

10,000

12,000FemaleMale

Source: FOI release: Number of individuals who have been disqualified from driving after a drink driving offence

Change in the number of breath tests carried out by police in England and Wales & the proportion that are positive

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 201252013 20140

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

0%

5%

10%

15%

20%

25%Number of tests Positive/refused (%)

Num

ber o

f bre

ath

test

s

Pro

porti

on o

f pos

itive

test

s

Source: Police powers and procedures England and Wales year ending 31 March 2015

Police carried out 607,000 breath tests in 2014, a fall of 10% compared with the 676,000 breath tests carried out in 2013.

Eleven per cent of breath tests carried out in 2014 were positive or refused, up one percentage point on 2013.

Drinking and crime

Number of offences committed pre and post treatment for alcohol use disorders

General Driver Violent Acquisitive Total0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

Pre-treatment Post-treatment “We observed a reduction in offending during a two-year follow-up after treatment for AUD (crude pre-treatment and post-treatment offending rate per 1000 falling from 221.5 to 169.4). Less offending was independently associated with completion of treatment (and long retention) and inpatient withdrawal management and/or pharmacological therapy.”

Source: Is treatment for alcohol use disorder associated with reductions in criminal offending? A national data linkage cohort study in England

Finds of alcohol in prisons in England and Wales, 2005 to 2014

2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

200

400

600

800

1000

1200Number of Incidents

Source: http://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/Commons/2016-01-06/21315 /

Problem drinking among women in England by violence and abuse typology and whether in poverty

Little or no violence and abuse

Physical violence from a partner

Sexual violence Extensive violence and abuse

0%

5%

10%

15%

20%

25%

30%Women in poverty Women not in poverty

Source: Joining the dots: The combined burden of violence, abuse and poverty in the lives of women (Agenda)

Prevalence of partner abuse victimisation in the last year, by sex and the frequency of drunkenness

Never Less than once every couple of months

Once every couple of months

Once a month Two or three times a month

Once a week or more

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0 Men Women

Source: Crime Statistics, Focus on Violent Crime and Sexual Offences, year ending March 2015

NB: Caution should be taken when making inferences about the relationship between alcohol consumption and partner abuse victimisation. The victims’ alcohol consumption may affect or be affected by their experience of partner abuse.

Two in five Scottish prisoners were drunk (41%) at the time of their offence

2008 2009 2011 2013 20150%

10%

20%

30%

40%

50%

60% I was drunk at the time of my offence I am worried that alcohol will be a problem for me when I get out

Source: Scottish Prison Service Prisoners Survey 2015

Alcohol and death

Rate per 100,000 of alcohol related deaths in the UK

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

5

10

15

20

25 Male Female

Source: Alcohol-related deaths in the UK, 2014

Number of deaths from alcohol related diseases in England and Wales in 2014 by sex and age group

05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-740

100

200

300

400

500

600

700

800

Male Female

Source: Avoidable mortality in England and Wales: 2014 ONS

Causes of death in alcohol related deaths registered in England in 2014

Chronic hepatitis, not elsewhere classified

Intentional self-poisoning by and exposure to alcohol

Alcoholic gastritis

Alcohol induced chronic pancreatitis

Degeneration of nervous system due to alcohol

Alcoholic cardiomyopathy

Accidental poisoning by and exposure to alcohol

Mental & behavioural disorders due to alcohol use

Fibrosis and cirrhosis of liver

Alcoholic liver disease

0 500 1000 1500 2000 2500 3000

Females Males

Number of deaths

Source: Alcohol-related deaths in the UK, 2014

Alcohol and money

Public attitudes to a minimum unit price for alcohol

0%10%20%30%40%50%60%70%80%90%

100%

Strongly againstSomewhat againstNeither in favour nor againstSomewhat in favourStrongly in favour Unfair to those on low

incomes

Effective at reducing heavy drinking

Effective at reducing young people's drinking

Unfair to sensible drinkers

Agree strongly Agree Neither agree nor disagree

Disagree Disagree strongly

Source: Attitudes to alcohol (NatCen)

Total Alcohol Duty Receipts per quarter(current and previous ten financial years)

2005

Q2

2006

Q1

2006

Q4

2007

Q3

2008

Q2

2009

Q1

2009

Q4

2010

Q3

2011

Q2

2012

Q1

2012

Q4

2013

Q3

2014

Q2

2015

Q1

2015

Q4

0

500

1,000

1,500

2,000

2,500

3,000

3,500

£ m

illio

n

▪ Total alcohol receipts followed a consistent pattern from 2005 to 2007, of around £2,000m per quarter, but with a peak during the final quarter of each calendar year (usually to around £2,200m, related to the Christmas period) followed by a dip in receipts in the first quarter of each calendar year (to approximately £1,600-£1,700m per quarter).

▪ From 2008 total receipts became slightly more volatile. The overall pattern remained the same however, with the lowest receipts being received by HMRC in the first calendar quarter of the year and highest receipts received in the final quarter. This may be attributable to there being two increases in duty rates in 2008 (one in March and one in December). Receipts have since trended upwards slightly, reaching their highest level recorded in Q4 2015, at close to £3,168m.

▪ In more recent years receipts from alcohol have been noticeably higher due to sustained periods of good weather, or major outdoor/sporting events, which typically increase alcohol receipts.

Source: Monthly statistics on clearances of alcohol products and duty receipts

Working more than 48 hours per week is associated with an increased risk of binge drinking

< 35 hours 35 - 40 hours

41- 48 hours

49 - 54 hours

> 55 hours0.7

0.8

0.9

1

1.1

1.2

1.3 “This systematic review and meta-analysis of 63 studies provides comprehensive evidence of an association between long working hours and alcohol use. Long working hours were associated with 1.11-fold likelihood of higher levels of alcohol use in the cross sectional analysis of 333 693 participants from 14 countries. A similar association (odds ratio 1.12) for new onset risky alcohol use was observed in a prospective analysis of 20 studies including 100 602 participants from nine countries. The associations were not dependent on participants’ sex, age, socioeconomic status, geographical region, type of study sample, prevalence of risky alcohol use in the cohort, or participation rate at follow-up. Eighteen prospective studies with individual participant data allowed us to perform a more refined comparison between work hour categories. Compared with the standard (35-40) weekly working hours, working 49-54 hours was associated with an odds ratio of 1.13 and working ≥55 hours a week was associated with an odds ratio of 1.12 for new onset risky alcohol use.”

Source: Virtanen, Marianna, et al. "Long working hours and alcohol use: systematic review and meta-analysis of published studies and unpublished individual participant data." BMJ 350 (2015)

Price per unit of alcohol in Scotland and England & Wales, by trade sector, 2000-2015

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 20150.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

1.80

2.00E&W - On-trade Scotland - On-trade E&W - CombinedScotland - Combined E&W - Off-trade Scotland - Off-trade

Pric

e pe

r uni

t (£)

Source: MESAS alcohol sales and price update May 2016

More than one third (36%) of the volume of alcohol sold in the off-trade (excluding discount retailers) in England & Wales in 2015 was at below 45 pence a unit of alcohol.

Under 30 p

30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85up0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

Source: MESAS alcohol sales and price update May 2016

Off licences in England and Wales sold 265.8 million litres of pure alcohol in 2015

Over half (54%) of strong ciders sold in the off-trade (excluding discount retailers) in England and Wales in 2015 were sold at below 20 pence a unit

Under 20p 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 640%

10%

20%

30%

40%

50%

60%There were 3.6 million litres of pure alcohol classified as strong ciders sold in the off-trade (excluding discount retailers) in England and Wales in 2015

Source: MESAS alcohol sales and price update May 2016

Alcohol and young people

Drinking behaviours of young people in Scotland, Wales and England15-year-olds who report first drunkenness at age 13 or younger

Scotland Wales England0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

12%

10% 10%

12%

10%9%

Girls Boys

Proportion of 15-year-olds that drink at least once a week

Scotland Wales England0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

11%12%

10%

16%

14%

12%

Girls Boys

Source: Health Behaviour In School-aged Children (HBSC)

Nearly 1 in 5 assessments of children in need in England in 2014/15 identified alcohol (17.8%) as issues in the family

North E

ast

North W

est

Yorksh

ire an

d The

Hum

ber

East M

idlan

ds

Wes

t Midl

ands

East o

f Eng

land

Lond

on

South

East

South

Wes

t0%

5%

10%

15%

20%

25%

Source: Characteristics of children in need: 2014 to 2015 (DfE)

Excessive alcohol use findings from “Suicide by children and young people in England” report

Male Female Under 18 18-19 years0%

5%

10%

15%

20%

25%

30%

35%

Alcohol use seen as excessive Family substance misuse “Most of the antecedents of suicide identified in this study—exam pressures, abuse, bullying, bereavement, physical health conditions, and self-harm—were more common in females. Males were less likely to be known to services.

“There were also differences in antecedents in those under 18 or 18-19 years old. Abuse, academic pressures and bullying were more common in those under 18, while excessive alcohol use, illicit drug use and serious self-harm were more common in 18-19 year olds.”

Source: Suicide by children and young people in England. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH). Manchester: University of Manchester, 2016.

n = 145

Alcohol and mental health

Monitoring of alcohol consumption in primary care among adults with bipolar disorder

Apr 2000 - March 2002

Apr 2002 - March 2004

Apr 2004 - March 2006

Apr 2007 - March 2009

Apr 2009 - March 20011

Apr 2011 - March 2013

0

100

200

300

400

500

600

700

800

900

88.6

168.3

244.7307.5

388

837.4

People with bipolar disorder People without servere mental illness

Rat

e of

alc

ohol

reco

rdin

g pe

r 100

0 pe

rson

-yea

rs 

The current high alcohol recording rates in people with bipolar disorder is very encouraging, especially given evidence that assessment of alcohol use alone (without subsequent intervention) can lead to reductions in hazardous drinking. Nevertheless screening is just a first step in the management of AUDs in people with bipolar disorder. To fully address the high prevalence of AUDs in this population, appropriate effective interventions need to be delivered, where indicated by the screening. Further research is needed to determine the extent to which alcohol interventions are implemented in people with bipolar disorder.

SMI QOF in effect

Alcohol screening added in SMI QOF

Source: Monitoring of alcohol consumption in primary care among adults with bipolar disorder: A cross-sectional and retrospective cohort study, Hardoon, Sarah L. et al. Journal of Affective Disorders , Volume 198 , 83 - 87

Number of patients in touch with mental health service in the last 12 months who died by suicide with a history of alcohol and/or drug use dependence in England

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

100

200

300

400

500

600

700

Alcohol

Drug

Source: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness

There were 6,151 suicides in patients with a history of alcohol misuse, 45% of the total sample, an average of 559 deaths per year. 4,435 had a history of drug misuse, 33% of the total sample, an average of 403 deaths per year. 7,391 had a history of either alcohol or drug misuse or both, 54% of patient suicides, an average of 672 deaths per year.

The number of suicides in patients with a history of alcohol or drug misuse has increased. Between 2012-2014, 240 (7%) patients were under drug services, 247 (7%) were under alcohol services, and 392 (11%) were under either drug or alcohol services.

And finally…

Would you stop drinking if your long term romantic partner asked you to?

45%

40%

15%Yes No

Not sure

Source: https://d25d2506sfb94s.cloudfront.net/cumulus_uploads/document/9ab2u5x5oi/Relationships_29-Jul-2016_Website.pdf