Alcohol treatment services expanded

The Department of Health has published a programme of improvement for alcohol treatment services, which includes £3.2 million for projects that catch the early stages of alcohol related problems.

The funding is planned for helping to identify people who might be damaging their health with alcohol. The Alcohol Needs Assessment Research Project, carried out as part of the exercise, estimates that there are 1.1 million adults with alcohol dependence in the UK and that eight million people drink above recommended limits.

The Needs Assessment Project also provides the most accurate picture yet obtained of the demands placed on treatment services and the amount of funding ploughed into them. It appears that around 63,000 alcohol dependent people receive specialist treatment each year, and the annual spend on specialist alcohol treatment is £217 million. There are approximately 4,250 whole time equivalent personnel working in specialist alcohol agencies in England.

Launching the initiative, Public Health Minister Caroline Flint said: “Alcohol misuse has a devastating effect on millions of lives every year. The publication of the alcohol treatment audit gives us, for the first time, a comprehensive understanding of the trends of alcohol misuse and service provision available across the country. We have found that treatment does make a real difference. By helping 10% of dependent drinkers to give up alcohol, we can save the public sector up to £156 million each year.”

To improve services, £3.2 million has been allocated to new initiatives which will help with identification and early intervention for people whose use of alcohol may be damaging their health. These projects will take place in different health and criminal justice settings.

They will be monitored and could provide the evidence needed to set up similar projects elsewhere. It is expected that by identifying the problem as early as possible, it will help avoid the serious damage that alcohol dependency has on the health of the individual as well as its negative effects on their relatives and society as a whole.

Also being developed as part of the Programme of Improvement are tools designed to help Primary Care Trusts improve the services for problem drinkers by providing practical steps and best practice examples of delivering treatment to those who need it.

From January 2006, the Department of Health will hold nine regional conferences to discuss with health providers how to use the Programme of Improvement to best effect in each area.

Alcohol needs assessment

The Alcohol Needs Assessment Research Project (ANARP) provides the first detailed national picture of the need for treatment and the availability of provision. The research was carried out by a consortium of organizations led by Professor Colin Drummond of St. George’s Hospital.

The main findings are:

A high level of need across categories of drinkers. 38% of men and 16% of women (age 16–64) have an alcohol use disorder (26% overall), which is equivalent to approximately 8.2 million people in England.

There are 21% of men and 9% of women who are binge drinkers. There is a considerable overlap between drinking above ‘sensible’ daily benchmarks and ‘sensible’ weekly benchmarks for both men and women.

The prevalence of alcohol dependence overall was 3.6%, with 6% of men and 2% of women meeting these criteria nationally. This equates to 1.1 million people with alcohol dependence nationally.

There was a decline in all alcohol use disorders with age.

In relation to ethnicity, black and minority ethnic groups have a considerably lower prevalence of hazardous/harmful alcohol use but a similar prevalence of alcohol dependence compared with the white population.

There is considerable regional variation in the levels of alcohol related need. The prevalence of hazardous/ harmful drinking varied across regions from 18% to 29%, whilst alcohol dependence varied between regions ranging from 1.6% to 5.2%.

In relation to the utilisation of alcohol services, the study found:

Although the majority (71%) of patients with an alcohol use disorder identified by GPs were felt to need qualitative research suggested that many were not referred because of two main factors: perceived difficulties in access, with waiting lists for specialist treatment being the main reason given; and patient preference not to engage in specialist treatment.

Both the qualitative and quantitative research identified a high level of satisfaction with specialist services once access was achieved.

Drug Action Teams (DATs) receive funding from a range of sources including primary care trusts, local authorities and charitable funds. In the quantitative survey of DAT professionals, 86% of respondents said that their alcohol treatment budgets are much lower than drug budgets.

Although not required to do so, 60% of DATs surveyed reported having a local alcohol strategy in place.

In the qualitative research with DAT professionals, this group was aware of a ‘very large gap’ between the provision of alcohol treatment and need or demand, however it is expressed.

The specialist alcohol agency survey successfully identified 696 agencies providing specialist alcohol interventions. This research has revealed 43% more agencies than identified in previous research.

The mapping exercise identified considerable regional variation in the number of agencies, with London having the largest number of agencies and the North East the fewest.

The largest proportion of referrals to alcohol agencies are self referrals (36%) followed by GP/primary care referrals (24%).

The estimated annual spend on specialist alcohol treatment is £217 million. The number of whole time equivalent personnel working in specialist alcohol agencies across England is approximately 4,250.

The average waiting time for assessment was 4.6 weeks. The shortest average wait fora region was 3.3 weeks and the longest wait was 6.5 weeks.

The gap analysis estimated the number of alcohol dependent individuals accessing treatment per annum is approximately 63,000, providing a Prevalence Service Utilisation Ratio (PSUR) of 18 (5.6% of the in need alcohol dependent population accessing alcohol treatment per annum or 1 in 18).