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The National Alcohol Strategy - One Year On
Models of Care for Alcohol Misuse
Prevention and Brief Interventions
Back to apas annual report contents
The National Alcohol Harm Reduction Strategy One Year On Looking back to the beginning of the last financial year we saw the publication of the National Alcohol Strategy. It provided an opportunity to bring alcohol to the forefront and make some far-reaching changes to improve the national toll of alcohol misuse. Information,
education and communication were one of the big areas highlighted that would
include targeted education programmes for specific groups, better labelling of
alcoholic drinks and stricter controls on TV advertising. Health
was also a major consideration with promises to better identify and treat
alcohol misuse and recommendations for a national
audit of alcohol services, the production of a national framework for service
provision and studies to look at early interventions. Law and disorder was as always a pressing concern, it was an opportunity for tackling alcohol related crime, review licensing policies and to improve alcohol service provision within the prison and probation services. Finally
we were promised closer working relationships with the alcohol industry who were
to be encouraged to take more responsibility for alcohol related harm, ranging
from responsible promotions to financial contributions towards the costs of
alcohol misuse. So
how far are we along the road to achieving these goals? Education & Information Young people are one of the specific groups targeted for alcohol education by last year’s strategy. However, the recently published document “Smoking, drinking and drug use among young people” reported that in 2004 the proportion of pupils remembering having lessons about alcohol fell to 52%, the lowest it has been for 10 years. Advertising
has long been recognised as a powerful medium for shaping opinions and so
Ofcom’s stance against irresponsible adverts is to be applauded. In November
2004 they revealed clear and strict guidelines, which leave the industry with no
doubt as to where they stand legally should they flout them. Although
it is pleasing to see an increase in the number of labels on alcoholic drinks
telling the consumer how many units they are drinking, the lack of general
public knowledge relating to units and recommended limits somehow dampens this
small success. Public education is the huge task that stands before any changes
in our attitudes towards alcohol and drinking culture can be achieved. Health Once again, with the publication of the “Choosing Health” white paper in November 2004, alcohol was raised as a public health concern alongside smoking, mental & sexual health, diet and exercise. Although to some extent it mimicked what was published in the harm reduction strategy for alcohol, it set deadlines for the production of national guidelines on how national alcohol treatment services should be organised and delivered and for the local and national audit of existing treatment services for alcohol. Although the National Treatment Agency fulfilled their obligations by producing the Models of Care of Alcohol Misuse, based on the existing drug strategy, by May of this year, we are still awaiting the completion of the promised audit of local and national services from the Department of Health. Pilot schemes are also currently underway to address the shortcomings in early detection and intervention of alcohol misuse problems within the National Health Service, as recommended in last year’s strategy, we will await the findings of these with much interest! Law and Order With the publication of the Violent Crime Reduction bill in June of this year came the recognition of the long known link between violent crimes and binge drinking as well as new methods to deal with alcohol related crime, including the use of drink banning orders and Alcohol disorder zones. Tougher punishments were also promised for those caught selling alcohol to children. The Home Affairs select committee report on Anti-social behaviour published in April 2005, also highlighted the link between alcohol and antisocial behaviour. Recommendations included minimum pricing schemes and the call for licensed premises to pay towards the costs of extra policing or out of hours transport. Many feel with the moves to give power to local authorities to deal with licensing issues, as proposed in the new Licensing act, the problems of alcohol related crime will increase further. With current plans to introduce 24-hour drinking in an attempt to introduce a European style culture, action needs to be taken soon to address these issues. December 2004 saw the Prison services announce the framework for their alcohol strategy, the National Probation Service are also currently working on their own alcohol strategy. All that remains to be seen is whether the funding will arrive to support these. Working with the Alcohol Industry Despite the wishes of the Government for the alcohol industry to take more of an active role in responsible retailing current evidence suggests that this is still a long way from happening. Over 50% of the licensed premises investigated last year were found to be selling alcohol to underage drinkers, as were a third of the off licenses that were targeted in the police crack down. The sale of alcohol to intoxicated customers is also still a problem leading to a high number of alcohol-related crimes highlighted above. So where are we at with the National Strategy for the reduction of alcohol related harm? Although there has been some improvements and there is still more encouraging stuff in the pipeline, the strategy on the whole is failing to live up to all it promised and certainly all it could have achieved. Despite all the recommendations for improvements to services and provision of training there is no money to support this. Clearly the cost of alcohol misuse to the country is acceptable when compared to the vast amount of money the government would lose from the alcohol industry if they actually followed through with their own findings and recommendations.
This
is often a question new clients, frustrated by the fact that they cannot control
their drinking, ask us. They know their drinking is causing problems but they do
not really want to stop, if they can pinpoint a cause then maybe there is a
cure? Much research has been carried out to investigate the
causes of alcohol misuse and as with any trait that displays such a wide
spectrum of ‘symptoms’ and severity there are numerous contributing factors. Genetic
Predisposition
It
has long been accepted that substance misuse seems to ‘run in families’ so
what is the evidence for an inheritable trait? When looking at inherited traits,
twin studies and adoptive studies are particularly useful. Twin
studies investigate the occurrence of a particular trait between identical twins
(who share 100% of their genetic information) and compare it with the occurrence
rates seen for that trait between unidentical twins (who share 50% of their
genetic information). If there are genetic factors involved then its occurrence
in both identical twins will be higher than its occurrence in both unidentical
twins, this is indeed the case in alcohol studies, demonstrating a clear role of
genetics in alcohol misuse. In
adoptive studies, where a child has been removed from its biological parent’s,
investigators look to see if a trait seen in the adopted person is present in
the adoptive parents or the biological parents. If present in the adoptive
parents only, the trait is more likely to be due to environmental factors, if
present in the biological parents, it is more likely to have a genetic element.
In alcohol studies it was found that if one of the biological parents had an
alcohol problem it was 3-4 times more likely that the adopted child would
experience alcohol problems in later life. Both
of these types of studies provide strong evidence for the involvement of
inheritable factors or a predisposition to alcohol misuse. However, they do not
explain the whole story, so far no single gene has been found to explain all the
alcohol problems that we see. It is more likely that there are several genes
involved in predisposing a person to alcohol dependency and abuse. Some of these
genes will affect personality and emotions and some of them will be involved in
physiological processes i.e. the way the brain responds to alcohol. Environmental
Factors
As
demonstrated genetic factors are not 100% responsible for alcohol problems so
what is it in our environment that affects how we use alcohol? Families
are obviously very important in terms of exposure to and experience of alcohol.
As well as picking up drinking patterns and behaviours from our parents and
extended family we also pick up their attitudes towards drinking, which affects
how we view alcohol and how we might use it in the future. Friends
/ peer pressure is a very strong influencing factor on drinking behaviour. Being
around people who drink normalises it and if you are in a group where heavy
drinking is the norm, you are more likely to drink heavily yourself. Also if
friends are drinking there can be direct or indirect pressure to use alcohol. Society,
Culture, and Religion are also important influencing factors. The drinking
culture in the UK at present is a worrying one when compared with our companions
on the continent. Theirs seems to be a much more relaxed style of drinking,
which is more to do with enjoyment than getting off their face as seems to be
the case here in the UK. In some cultures or under some religions it is
unacceptable to use alcohol at all whilst alcohol is widely accepted (and used)
in our society. Advertising
and the way alcohol is portrayed by the industry through association with
certain celebrities or activities makes drinking seem more glamorous and
acceptable encouraging people to drink more. Availability, in terms of how
easily you can get your hands on it, as well as cost (2-4-1 promotions etc) is
also an important determinant of how much someone drinks. The
reasons people drink are also worth considering, in a time where stress and
depression levels seem to be at an all time high, is it any wonder that more
people are using alcohol to relax, unwind and drown their sorrows? So
we come full circle and back to the fact that there are many factors that
contribute to alcohol misuse, but perhaps the more important question we should
ask is how do we deal with it? So far there are a few candidate genes identified which may prove to be useful markers for identification of alcohol misuse in the future and may also provide specific targets for future drug treatment. As for environmental influences we need to start by looking at better education around sensible drinking and the harm alcohol causes before we can start to address and change existing attitudes and behaviours relating to alcohol use.
The recently published document “Smoking, drinking
and drug use among young people in England 2004” investigates the smoking,
drinking and drug using trends amongst young people over the last 10-15yrs. The findings show that the percentage of pupils who
had consumed alcohol within the last week had dropped from a high of 28% in 2001
to 23% in 2004. However, the average amount of alcohol consumed throughout the
week had risen from 5 units a week in 1990 to around 11 units per week from 2000
onwards. The most popular days for drinking were over the
weekend especially Friday and Saturday, although a worrying number of young
people also reported drinking during the week.
Around 70% of pupils who had reported drinking in the last week
identified beer, lager and cider as their drink of choice, with 65% reporting to
have drank spirits and / or Alcopops. The number of pupils buying drinks from off licences
had decreased by around 40% but the number of young people getting alcohol from
family or friends had almost doubled. The most popular place for young people to
consume alcohol was at home or in someone else’s home, although there was a
significant increase in numbers of young people drinking away from home as they
got older. When questioned about the consequences of their
drinking 51% of pupils had got into an argument or had a fight, 49% had lost
money or lost / damaged their belongings. 11% reporting getting into trouble
with the police and 3% were taken to hospital. When compared with our study carried out last year in
schools in the North of Nottinghamshire we found that over 30% of the pupils
questioned had consumed alcohol in the last week. 50% of the pupils questioned
estimated that they drank between 4-6 units on a typical drinking occasion. (The
department of health recommends that females drink no more than 3units per day
and males no more than 4units per drinking occasion) In our study over 90% of pupils reported their drink
of choice as lager, beer and cider and / or Alcopops, 40% reported drinking
spirits. 20% of pupils said they bought their own alcohol with only 5% saying
they got it from family or friends. When questioned about the consequences of their
drinking 37% of pupils said they had done something they had later regretted,
16% reported having arguments with family or friends, 17% said they had broken
the law and 11% reported problems with their health due to drinking. Overall the results paint a pretty grim picture,
young people are starting to drink from an earlier age and they are drinking
more heavily then ever before. Recent evidence has highlighted the increased
numbers of young people contacting services for support with alcohol problems
and an increased number of alcohol related medical problems in younger people.
Liver problems that were previously only seen in people in their 60’s are now
being observed in people as young as 30. There has also been an increase in the
number of young people brought to A&E after alcohol related accidents or
alcohol poisoning and an increase in teenage pregnancy and sexually transmitted
infections. As well as the costs to health there is also an
increase in alcohol related crime and disorder, the 65% of suicides that alcohol
plays a role in, the 50+% cases of child protection and domestic violence where
the perpetrator has been drinking. Lets not forget truanting, poor levels of
schoolwork and in later life the cost to employers due to alcohol-related
sickness, tardiness and absenteeism. The Governments harm reduction strategy for alcohol,
published last March, highlighted education as a key target for reducing
alcohol-related harm with a particular focus on young people. Ironically the
“Smoking, drinking and drug use among young people in England 2004” document
shows that percentage of pupils remembering specific lessons about alcohol was,
at 52%, the lowest it has been since 1996! Despite the gaps in alcohol and drug education
highlighted by our own study in North Nottingham there is a partial silver
lining. A significant proportion of younger pupils remembered and commended the
DARE education programme due to the methods of teaching and material content.
Although the older pupils were more likely to have forgotten this, educating
pupils again at a later stage to consolidate and build on this earlier learning
seems to be an obvious way forward. When asked about the sources of learning relating to
alcohol and drugs a large proportion of pupils in our study said they found
visits from outside agencies more interesting and educational. As a high
proportion of pupils reported getting most there knowledge from parents or
teachers it would also make sense for specialist agencies to deliver training
for them also to reinforce what the pupils are learning at school.
In terms of learning materials, interactive and fun
methods such as role plays, drama and group activities were by far and away the
most popular followed by TV, videos and personal experiences. When questioned
about educational topics relating to alcohol and drugs, pupils reported that the
wider issues relating to alcohol and drug use covering family, relationships,
health and young people in particular would be of interest to them. So how have we made use from what we have learnt from
the young people in our study? Since compiling the results of our study, we have
devised a new training plan for the alcohol awareness sessions that we carry out
in schools, which include role-plays, case studies based on personal experiences
and group activities, providing information on a spectrum of alcohol related
issues. So far the sessions we have carried out with these new methods and
materials have been highly successful, with 26% of pupils selecting our workshop
as the best out of the five workshops delivered at a recent healthy choices
conference. We are getting involved in more school and community training and awareness than ever before and our aim is to provide even more to all sorts of community and professional groups. We hear DARE is running a trial focusing on follow up alcohol and drug education in secondary schools so we will eagerly await the results of that. In the meantime similar initiatives will no doubt be happening across the rest of the country but what about a bit of co-ordination and sharing of best practise? It is only en masse that we can start to make a big enough difference to educate and change society view.
apas
and Models of Care for Alcohol Misusers One of the recommendations of last years National Alcohol Harm Reduction
Strategy was to be able to increase the identification of alcohol misuse and to
improve treatment for alcohol misusers. The “Choosing Health” white paper,
which highlighted alcohol as one of the main public health issues, built on this
calling for a national framework for the commissioning and provision of local
alcohol services. The National Treatment Agency was given the task of producing
Models of Care for alcohol treatment and interventions and the final draft of
the Models of Care for Alcohol Misuse or MoCAM, (based on the 2002 Models of
care for drug misusers), was published in May 2005. In order to provide a service for alcohol misusers MoCAM recognised that
we must first account for the different types of drinking that we see in people
who misuse alcohol and also consider the different goals and therefore
interventions that are available. As well producing a national treatment
framework based on a four tier model of treatment services, MoCAM also outlines
the importance of having national standards for people working within this area
and national standards that treatment programmes must adhere to. The Four
Tier System
MoCAM identified four levels of service provision, it is recommended that
services from each tier should be represented in any local area, it is important
for services at all tiers to work together in a co-ordinated way to aid shared
care across the tiers and referrals between them. The higher tiers can provide
the services carried in the lower tiers as well as their more specialist
services. Tier one Identification of hazardous and harmful drinkers, some advice on reducing
alcohol related harm, referral to higher tier services if appropriate. Can be
delivered by a number of agencies including primary health team, hospital staff,
police, prison or probation, social services, education, training, housing,
employment services. Tier two Open access facilities providing alcohol specific advice, brief
interventions to help reduce alcohol related harm, assessment of problem and
referral on to higher tier services if appropriate. Delivered by specialist
alcohol agencies or some primary healthcare staff, social services, prison and
probation, housing or occupational health services. Tier three Community based specialist alcohol treatment to include assessment, care
planning and shared care approaches. Delivered by statutory, voluntary or
independent specialist alcohol support services and some agencies with
specialist alcohol treatment facilities. Tier four Residential or inpatient specialist alcohol treatment including assessment
and care planning and shared care approaches. Delivered by specialist inpatient
or residential facilities including specialist medical wards or community
projects. Where does
apas fit in to MoCAM?
apas carries out
work within tiers 2 & 3 of the MoCAM model whilst also providing some
services in tier one, referrals to services at all tiers and training to staff
working for services in tiers 1&2. The client journey through apas is
tailored to take into account the type of drinking and the type of intervention
that best fits the client needs and goals. In this we believe we have an
advantage over services that only offer one type of intervention or only
recognise one type of drinking. We believe that we fit well into the MoCAM
framework by providing specialist, individual advice to our clients.
Prevention
and Brief Intervention – the way forward? apas is a firm
believer of early interventions, brief interventions and prevention through
education and training. This also relies of course on the investment of funding
in lower tier services to provide prevention rather than expensive end stage
interventions. As a cost effective tier 2 service we can give advice and support
that prevents clients ending up at the later more intensive and expensive tier 4
service level. By providing alcohol awareness training, as we do, to tier one staff
(including healthcare professionals, probation and prison officers, teachers,
youth workers, social workers, and employment and housing agencies) we feel that
we can help in earlier and better identification of alcohol problems at lower
tier levels. We regularly provide awareness and training sessions to people throughout
the community, including young people in schools and youth clubs, people in
prison or on probation, people attending employment, housing or training
facilities, as well as at general community events. By providing training and
awareness to the public so there is an awareness of units, recommended drinking
limits and dangers of exceeding these we feel we can start to address the
problematic attitudes that lead to the current, harmful drinking trends seen
across the UK. First and foremost is the saving to the individual, if they are able to
recognise earlier the damage that their drinking causes they may end up getting
off the therapeutic path earlier. That way they avoid the risk of permanent
damage to their physical or psychological health, loss of family and friends,
trouble with the law, debts, housing or employment problems and so on. Similarly for the family if they and / or the drinker receive education
and support earlier they might be saved the physical or emotional trauma
including domestic violence and child abuse, family breakdown, money / housing
worries and other problems that long term, heavy drinking often lead to. If there is less binge drinking and heavy drinking they will be a fall in
public disorder, including violent crime, antisocial behaviour, drink driving
and drug use, all of which alcohol contributes to. As well as being victims of
alcohol related crime, as taxpayers we foot the bill for it, which is currently
a whopping £7.3 Billion per year. We also pay for the National Health Service, which currently spends £1.7billion
a year on alcohol related harm including long term problems caused by drinking
(liver problems, mental health) and the short terms consequences of it
(accidents, alcohol poisoning, suicides). Employers lose an estimated 11-17
million work days a year through alcohol related sickness and absenteeism which
currently costs our economy around £6.4billion each year. By educating the public generally as well as training
professionals to identify and address alcohol problems earlier we can really
start to cut the cost of alcohol related harm.
Charities
depend more and more on the generosity of individuals, a legacy is a simple way
of giving to your chosen charity in the future and you will have the
satisfaction of knowing that you will be continuing to support a worthy cause. Types
of legacies
· Pecuniary legacies where you leave a specified sum of money to your chosen charity in a one off payment after your death. · Specific legacies where something in particular is left to your chosen charity such as shares or a piece of furniture. ·
Residual Legacies where you leave a part of the residue of
your estate to your chosen charity. Why
leave your money to apas?
Every year our work contributes to a greater understanding of the causes, nature and extent of alcohol problems. We support research that leads to initiatives that ‘make a difference in your community’ and with extra support we are better able to provide effective treatment to those in need irrespective of their position in society or geographical location. As an independent charity we are not tied to any one philosophy relating to cause or treatment and offer unbiased, person specific care. When
drawing up, adding to or changing your Will, it is always sensible to consult a
solicitor to ensure that it is legal and cannot be challenged after your death.
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