Interventions to tackle harmful alcohol consumption

Guidance providing practical steps to improve screening and brief interventions for problem drinkers or people drinking to hazardous levels has been published by theDepartment of Health.ⁱ

‘The guidance’, explained Minister, “supports organisations thinking about developing the alcohol misuse interventions that will help improve health, reduce inequalities, reduce demand and improve access for the NHS”.

The document provides further detail on the policy context and evidence of harm to the NHS, to individuals, families and communities. It presents powerful economic arguments for action, identifies practical steps for those implementing this guidance locally and introduces new, nationally developed tools that can be used by local organisations.

Findings from ANARP

The 2005 ‘Alcohol Needs Assessment Research Project (ANARP)’ report had already provided the first detailed national picture of the need for treatment and the availability of provision. The evidence presented suggests that the prevalence of Alcohol Use Disorders (AUD’s) and access to treatment varies considerably across England. Indeed, there are important discrepancies in terms of levels of hazardous and harmful drinking, and the provisions of treatment. Some areas present high levels of hazardous drinking, which manifests itself in terms of alcohol-related crime and disorder and is typically associated with a younger population. On the other hand, some regions present high levels of harmful drinking, more often associated with dependent drinkers, who are usually older and are more likely to experience a range of health harms.

There are also wide regional disparities in terms of the provision of alcohol treatmen services, which aim to benefit an older, dependent drinking population. It is also noted that people with alcohol dependence are heavy consumers of health services, but are not often identified as having alcohol dependence.

Alcohol misuse is now costing around £20 billion a year in England, it is suggested, including alcohol-related health disorders and diseases. This figure encompasses the costs of crime and antisocial behaviour, loss of productivity in the workplace, and problems for those who misuse alcohol and their families, including domestic violence. Evidence based alcohol treatment in the UK could result in net savings in the ratio of £5 saved for every £1 spent.

Making it happen locally, regionally and nationally

The new guidance outlines practical steps that Primary Care Trusts (PCT’s) can take. These include assessing local need, current provision and levels of investment for screening, brief interventions and services for dependent drinkers across the local health and social care economy. As part of an assessment of local need for the entire pathway, greatest impact may be made if screening and brief interventions are offered to hazardous and harmful drinkers.

The regional support to deliver local programmes includes a series of conferences, held from January 2006 in partnership with the DH Regional Directors of Public Health to discuss the emerging evidence and practice.

The sum of £15 million per annum will be included within the PCTs’ general allocation from 2007/2008 onwards to help PCTs’ improve their local arrangements for commissioning and delivering alcohol interventions.

A number of ‘Trailblazer Projects’ are to be implemented with the aim of strengthening the evidence base, in assessing and determining the impact of targeted screening and brief intervention within key settings: primary care, hospital and criminal justice systems. These projects are to begin in Spring 2006, with a final report released by the Summer 2008.

The Guidance summarises the economic justification for interventions into harmful and dependent drinking:

Potential benefits of interventions

Recent studies suggest that alcohol treatment has both short and long-term savings, and analysis from the UKATT Study suggests that for every £1 spent on treatment, the public sector saves £5.

The provision of alcohol treatment to the 10% of the dependent drinking population within the United Kingdom would reduce public sector resource costs by between £109m and £156 m each year. The direct cost of brief intervention delivered to hazardous harmful drinkers was calculated to be only £20 in 1993.

A recent trial found that brief intervention trials can reduce weekly drinking by between 13% and 34%, resulting in 2.9 to 7.8 fewer mean drinks per week, with a significant effect on recommended or safe alcohol use.

Evidence suggested that hazardous and harmful drinkers receiving brief interventions were twice as likely to moderate their drinking 6 to 12 months after an intervention, whenc ompared to drinkers receiving no intervention.

If consistently implemented, GP based interventions would reduce levels of drinking from hazardous or harmful to low risk levels for 250,000 men and 67,500 women each year.

Reference

i Alcohol Misuse Interventions – Guidance on developing a local programme of improvement. NHS National Treatment Agency for Substance Misuse. Department of Health 2005