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Alcohol

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Introduction

More than 9 million people in England drink more than the recommended daily limits. Alcohol is 10% of the UK burden of disease and death, making alcohol one of the three biggest lifestyle risk factors for disease and death in the UK, after smoking and obesity. The most effective 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 interventions with at-risk drinkers, and treatment of drinkers with alcohol dependence

Alcohol misuse in the North West of England is the worst in the UK, and Blackpool has high levels of alcohol related harm (health, disorder, violence) for the size of the population. The health and wellbeing of the community and local services are strained. The alcohol industry brings some economic prosperity through employment, yet paradoxically 105,000 working days a year are lost in Blackpool due to alcohol misuse, at an estimated cost upwards of £10.5 million per year.

Blackpool has a thriving and vibrant night-time economy, and like many UK towns and cities, that economy centres around entertainment premises licensed to sell alcohol. Once seen by planners as the answer to troubled town centres, pubs, clubs and bars are a major focal point for alcohol related harm; alcohol is having a significant negative impact on health, crime and the economy. In 2015, Blackpool had 130 on-licensed premises in a compact town centre, an area of approximately one square mile. In 2015, a total of 1,900 licensed premises existed in the entire town: approximately one for every 72 residents.

Alcohol misuse is not a new phenomenon to Blackpool. According to local historians, Blackpool in the Victorian era hosted destination drinking. The challenges facing us today are a powerful alcohol industry, an above average prevalence of harmful attitudes towards alcohol, and an environment and culture that support excess alcohol consumption.

Facts and Figures

Patterns of consumption

    • Low-risk drinking is defined as drinking within Government guidelines and making a personal assessment of particular risks and responsibilities at the time.
    • Increasing risk drinking is defined as drinking more than the sensible drinking guidelines but without having experienced any alcohol-related harms.
    • Higher risk drinking is defined as drinking more than the low risk drinking guidelines and already experiencing some alcohol-related harms (but no dependence).
    • Dependent drinking is defined as (normally) drinking more than the low risk drinking guidelines, experiencing alcohol-related harms and signs of psychological and/or physical dependence.
    • Binge drinking generally refers to drinking large amounts of alcohol in a limited time period. It is usually defined as more than six units for women and more than eight units for men in one occasion, however binge drinkers may sit in any of the drinking risk groups.

Figure 1 demonstrates how alcohol drinking behaviour is classified and gives estimates for the proportion of the Blackpool population that fall into each group. The more units regularly consumed per day increases the risk factor, whilst binge drinkers could drink at any level normally with an occasional binge. Dependent drinkers are predominantly a subset of either increasing risk or high risk drinkers, however recovering drinkers could be abstinent but remain dependent.

Figure 1 - Patterns of alcohol consumption

Figure1
Source: PHE, Local Alcohol Profiles for England

Geographical variation

Patterns of alcohol consumption vary between different wards across Blackpool. Figure 2 shows modelled binge drinking prevalence expressed as a percentage of the population by ward in Blackpool. The wards in the centre of the town which experience higher levels of deprivation also see the highest prevalence of binge drinking.

Figure 2 - Modelled Estimate of Binge Drinking by Ward

  Figure2
Source: PHE, Local Health

Health

Alcohol is a major cause of ill health; it causes and contributes to a wide range of serious health problems, accidents and deaths. Alcohol causes and contributes to numerous health problems including liver and kidney disease; cancers of the mouth and throat, liver, larynxl, colon and breast; acute and chronic pancreatitis; heart disease; high blood pressure; depression; stroke and foetal alcohol spectrum disorder. In most cases, the relationship between alcohol and disease is 'dose-dependent' - that is the more alcohol consumed, the greater the risk of disease.

Mortality

Figure 3 shows that Blackpool is significantly worse than the England average on all alcohol mortality indicators. Some indicators show Blackpool is the worst in the country, including alcohol-specific mortality for males, mortality for chronic liver disease for all persons and mortality for chronic liver disease for males.

Figure 3 - Alcohol and Mortality

Alcohol-mortality-spine-charts
Source: PHE, Local Alcohol Profiles

Alcohol Specific Mortality

    • Definition: Deaths from alcohol-specific conditions, all ages, directly age-standardised rate 100,000 per population. Deaths from alcohol-specific conditions include all causes of death from Ethanol poisoning, Methanol poisoning and the toxic effect from alcohol.

Figure 4 shows alcohol specific mortality for males in Blackpool compared to England as a whole. Although the rate in Blackpool is showing a gradual decrease since 2009, the rate is still significantly higher than the national average. 92 male deaths, directly caused by alcohol-specific conditions, were recorded in 2011-13.

Figure 4 - Alcohol Specific Mortality Trend - Males

Figure4
Source: PHE, Local Alcohol Profiles

Figure 5 shows alcohol specific mortality for females in Blackpool compared to England as a whole. The rate in Blackpool has shown a gradual downward trend since 2009. The rate is also still significantly higher than the national average. 36 female deaths, directly caused by alcohol-specific conditions, were recorded in 2011-13.

Figure 5 - Alcohol Specific Mortality Trend - Females

Figure5
Source: PHE, Local Alcohol Profiles

Alcohol Related Mortality

    • Definition: Mortality from alcohol-related conditions, directly age-standardised rate, all ages, per 100,000 per population. Includes; conditions wholly-attributable and partially-attributable to alcohol.

Figure 6 shows alcohol related mortality for males in Blackpool compared to England as a whole. The rate is significantly higher than the national average. In 2013, there were 75 alcohol-related deaths of Blackpool residents.

Figure 6 - Alcohol Related Mortality Trend - Males

Figure6
Source: PHE, Local Alcohol Profiles

Figure 7 shows alcohol related mortality for females in Blackpool compared to England as a whole. Although the rate had seen a decrease, reaching similar rates to the England average in 2011 and 2012, by 2013 the rate began to rise again. In 2013, there were 37 alcohol-related deaths of Blackpool resident females.

Figure 7 - Alcohol Related Mortality Trend - Females

Figure7
Source: PHE, Local Alcohol Profiles

Hospital admissions due to alcohol

Alcohol-related hospital admissions can be a result of regular alcohol use above lower-risk levels and are most likely to be found in increasing-risk drinkers, higher-risk drinkers, dependent drinkers and binge drinkers. Health conditions in which alcohol plays a causative role can be classified as either 'alcohol-specific' or 'alcohol-related'.

Alcohol specific hospital admissions

    • Alcohol specific admissions relate to admissions where alcohol is causally implicated in all cases, e.g. alcohol poisoning or alcoholic liver disease.

Figure 8 shows the trend in alcohol-specific hospital admissions in people of all ages.

Figures 8 - Alcohol Specific Hospital Admissions Trend

Figure8
Source: PHE, Local Alcohol Profiles

The rate of alcohol specific hospital admissions has increased between 2008/09 and 2013/14, both locally and nationally. Blackpool has significantly higher alcohol specific hospital admissions than the national average.

Alcohol related hospital admissions

    • Alcohol related admissions include all alcohol-specific conditions plus those where alcohol is causally implicated in some but not all cases, for example high blood pressure, various cancers and falls.

Alcohol related hospital admissions are split into two types of measure; broad and narrow.

The broad measure is an indication of the totality of alcohol health harm in the local adult population.

Figure 9 shows the trend in alcohol related hospital admissions between 2008/09 and 2013/14 using the broad measure. Alcohol related admissions include all alcohol-specific conditions plus those where alcohol is causally implicated in some but not all cases, for example high blood pressure, various cancers and falls. The rate of alcohol related hospital admissions has risen both locally and nationally.

Figure 9 - Alcohol Related Hospital Admissions - Broad Definition Trend

Figure9
Source: PHE, Local Alcohol Profiles

Figure 10 shows the highest rates of alcohol related hospital admissions are concentrated in Blackpool's most disadvantage communities, in the centre of the town.

Figure 10 - Alcohol Related Hospital Admissions - Broad Definition - Ward Map

Figure10
Source: PHE, Local Health

The narrow measure shows the number of admissions where an alcohol-related illness was the main reason for admission or was identified as an external cause. This definition is more responsive to change resulting from local action on alcohol and is included as an indicator in the Public Health Outcomes Framework.

Figure 11 shows the trend in alcohol related hospital admissions between 2008/09 to 2013/14 using the narrow measure. Blackpool has the highest rate of alcohol related hospital admissions, using the narrow definition, of any local authority in England.

Figure 11 - Alcohol Related Hospital Admissions - Narrow Definition Trend

Figure11
Source: PHE, Local Alcohol Profiles

Crime and Disorder - Alcohol-related Crime Incidents

Alcohol is too often a precursor and catalyst for crime and disorder in Blackpool in addition to creating health and safety issues in the wider community. Blackpool has one of the highest levels of alcohol related mortality in the country. It is a local authority containing some of the most deprived areas in Lancashire and in England. There is a correlation between Blackpool's areas of deprivation and hotspots for violent crime, domestic abuse, and criminal damage, all associated with alcohol abuse to some degree.

Visitors to Blackpool swell the local population significantly during summer months, and although they make a huge contribution to the local economy, including a substantial 'night time economy', they also contribute to the local crime statistics as victims or offenders. This 'tourism effect' does have negative impact on crime and disorder statistics.

'Alcohol-related' incidents are defined as those incidents where the victim perceived the offender(s) to be under the influence of alcohol at the time of the incident.

Figure 12 demonstrates that, although the number of alcohol related sexual crimes each year is small, Blackpool residents are significantly more likely to be victims are alcohol-related sexual crime then England as a whole. There were 41 case of alcohol-related sexual crime in 2012/13 experience by Blackpool residents.

Figure 12 - Alcohol-related Sexual Crimes

Figure12
Source: PHE, Local Alcohol Profiles for England

Figure 13 shows the number of alcohol-related violent crimes in Blackpool compared to the North West and England. Blackpool's reported rate of alcohol-related violent crimes is more than double the England and north west rate.

Figure 13 - Alcohol-related Violent Crimes

Figure13
Source: PHE, Local Alcohol Profiles for England

Figure 14 demonstrates the impact alcohol has on the rate of crime in Blackpool. Blackpool residents experience twice the rate of alcohol related crime than England as a whole.

Figure 14 - All Alcohol-related Crime

Figure14
Source: PHE, Local Alcohol Profiles for England

Between 2011/12 and 2013/14, there were 1,109 assault related emergency attendances at Blackpool Victoria Hospital which occurred in the home. Almost three-quarters (73%) resided in Blackpool unitary authority.

The Alcohol Treatment System

The following section provides detailed information on individuals who are in contact with structured alcohol treatment. The data has been taken from the National Drug Treatment Monitoring System (NDTMS). This system collects, collates and analyses information from and for those involved in the drug and alcohol treatment sector.

Figure 15 refers to individuals who were in treatment during 2014/15 and cited alcohol as their only substance misuse problem.

 ‘Horizon’

Horizon is the integrated drug and alcohol treatment service for residents of Blackpool.  The service provides care planned and integrated community based treatment for drug and alcohol clients.  Specifically, unstructured and structured interventions are available for people presenting with alcohol problems and one to one interventions are complemented by a variety of group work programmes.  Treatment options will depend upon the needs and complexities of each client.  Alcohol clients can receive brief advice and interventions within a number of community settings such as in GP surgeries and police custody, and are referred into more intensive support at the main treatment centre if required.  Structured treatment is care planned and consists of community based psychosocial interventions and clinical treatment.  Community detoxification and rehabilitation are also available to clients who would benefit from these approaches. Specific police and probation programmes are delivered to people where alcohol is related to offending behaviours and these include alcohol interventions to support treatment and offender prevention.

 Demographics of clients in alcohol treatment

The number of adults in alcohol treatment in 2014/15 in Blackpool was 574. The gender split for this number of adults was 64% male and 36% females. This compares similarly to the national average proportions by gender of 62% male and 38% female. The number of adults who started alcohol treatment in 2014/15 was 392. The age and gender breakdown of all adults in alcohol treatment in 2014/15 in Blackpool is shown in Figure 15.

Figure 15 – Adults in Alcohol Treatment 2014/15

Age groupNo. BlackpoolMale (%)Female (%)No. nationallyMale (%)Female (%)
18-29

73

12

14

9088

10

10

30-39

139

24

25

19461

22

22

40-49

199

32

40

29163

32

34

50-59

133

27

16

21679

25

23

60-69

26

5

4

8043

9

9

70-79

3

1

0

1468

2

2

80+

1

0

0

205

0

0

Source: NDTMS

Routes into treatment

Figure 16 shows the routes into alcohol treatment. Understanding this gives an indication of the levels of referrals from various settings into specialist treatment. Criminal Justice System (CJS) means referred through an arrest referral scheme via an Alcohol Treatment Requirement (ATR), prison or the probation service. The data highlights that, currently, the percentage of referrals into treatment from general practice is lower than the national average (7% locally compared to 19% nationally). All other sources of referral into treatment are showing similar levels to the national average. There is a need, locally, to focus on improving the numbers of referrals from GPs into Alcohol Treatment Services.

Figure 16 - Source of Referral into Alcohol Treatment 2014/15

 No. Blackpool% of new startsNational% of new starts
Self-referral

183

47%

27335

45%

Referred through CJS

41

10%

4619

8%

GP

28

7%

11950

19%

Hospital/A&E

29

7%

4692

8%

Social Services

7

2%

1104

2%

All other referral sources

104

27%

11223

18%

Source: NDTMS

Waiting times

People who need alcohol treatment need prompt help if they are to recover from dependence and keeping waiting times low plays a vital role in supporting recovery from alcohol dependence. In 2014/15, the number of adults waiting under three weeks to start treatment was 346, this is 97% of all initial waits and this compares to 95% nationally. The number of adults waiting over 6 weeks is 3 which is 1% of all initial waits and compares to 2% nationally.

Length of time in treatment

NICE Clinical Guidance CG115 suggests that harmful drinkers and those with mild alcohol dependence might benefit from a package of care lasting three months while those with moderate dependence might need a six month package and those with severe dependence or those with complex needs may need a package of care lasting up to a year. The length of a typical treatment period was around 6 months, although nationally 15% of clients remained in treatment for at least a year. Retaining clients for their full course of treatment is important in order to increase the levels of successful treatment completion and reduce rates of early treatment drop out. Conversely, having a high proportion of clients in treatment for more than a year may indicate that they are not moving effectively through and out of the treatment system.

In Blackpool the average days in treatment in 2014/15 was 210.3 days. This is in line with the national average.

Success of treatment

The following section relates to clients completing their period in treatment in 2014-15, and whether they completed successfully and did not return within 6 months.

The successful completions data provides an indication of the effectiveness of the treatment system in Blackpool.  A high number of successful completions and a low number of representations to treatment indicate that treatment services are responding well to the needs of those in treatment.

In Blackpool, the percentage of clients leaving alcohol treatment successfully in 2014/15 was 56% of all those in treatment (n.324). This is higher than the national average of 49%. And of the successful completions in Blackpool, 48% did not return within 6 months after completing treatment compared to 38% nationally.

Views, Attitudes and Experiences of the Local Community

Alcohol Inquiry

In 2013, Blackpool Council commissioned 'Drinkwise, Our Life' to deliver 'Talking Drink: Taking Action - The Blackpool Alcohol Inquiry' with participants being recruited from the area of Grange Park. The Inquiry ran for ten weeks from January to April 2014. The sessions were held at The Cherwell Centre on a Wednesday between 12.00-2.30pm.

The Talking Drink: Taking Action series has been designed to empower and enable the community to articulate an informed view of the actions that individuals, communities, organisations and decision-makers should support and adopt to reduce alcohol related harm. The Blackpool Alcohol Inquiry enabled local residents who may have not been involved in decision making processes in the past to become part of a local group that explored the issue of alcohol in their area. Our Life created a discussion around alcohol and helped put informed opinion at the fingertips of the inquiry participants so that they themselves could come to their own conclusions.

The Inquiry aimed to involve the participants in a lengthy discussion to try and answer the question 'What needs to happen to make it easier for people to have a healthier relationship with alcohol?' On June 4th 2014, the group presented their recommendations to local stakeholders and policy makers

Blackpool Lifestyle Survey 2015

The Blackpool Lifestyle Survey 2015 survey highlighted:

    • Proportions of high, increasing and lower risk drinking are similar across deprived and more affluent areas.

    • Almost a quarter of drinkers in Blackpool report binge drinking, that is drinking six or more units of alcohol if you're female, or eight or more units of alcohol if you're male, in one session in the previous seven days.

    • Men, the disabled, those who rent and those who are finding things very difficult financially are significantly more likely to binge drink.

    • Retired people are significantly less likely to binge drink.

    • Females in the most deprived areas are more likely to binge drink than in other areas, male binge drinking is similar across all areas.

    • Although binge drinking is highest in the most disadvantaged areas, it also increases in the least disadvantaged areas in working age people.

Night Time Economy Working Group (NTEWG)

In February 2014, as part of its decision not to recommend an Early Morning Restriction Order, the Licensing Committee did recommend that the Council create a working group to consider all of the issues that were of concern in the night time economy in Blackpool.

The Council agreed to the proposal and formed the Night Time Economy Working Group (NTEWG) with representatives from the Council, police, health, residents and the licensed trade.

This NTEWG report highlights the issues identified by the perceptions survey and the sub-group meetings and provides, in its recommendations to the Licensing Committee, measures targeted at improving the perceptions of Blackpool Town Centre.

National and local strategies

Recommendations

The following recommendations are from the strategy currently under development by the Blackpool Council Alcohol Steering Group on behalf of the Health and Wellbeing Board.

  1. Help to develop healthy attitudes to alcohol across the life course
  2. Change the environment and promote responsible alcohol retailing
  3. Early identification and support for alcohol issues