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Addressing the harm caused by alcohol is crucial to the improvement of public health and health inequalities. Reducing alcohol-related harm is one of the seven public health priorities and is considered key to achieving the National Health Service’s Five Year Forward View.
The misuse of alcohol can take a range of forms and affects citizens across the range of demographics in Nottingham. Both short and longer-term health harms resulting from the misuse of alcohol and especially dependence on alcohol are responded to by the city’s commissioned alcohol treatment model alongside primary and secondary care services. This Joint Strategic Needs Assessment (JSNA) identifies that, while solid progress has been made in improving the functioning of the commissioned model, there remains a substantial degree of need among the population. Where alcohol misuse intersects with other social and health issues there are also further public health concerns to be addressed.
This JSNA chapter focuses on alcohol use in adults. A chapter on substance misuse in young people is also available.
Unmet needs and gaps
- Almost twice as much alcohol is consumed in the home in the UK, whilst alcohol consumption outside the home has reduced by 50% over the last decade.
- More men than women drink at increasing and higher risk level and binge drink both locally and nationally
- Drinking alcohol during pregnancy can increase the risk of miscarriage, foetal Alcohol Syndrome (FAS), Foetal Alcohol Spectrum Disorders (FASD), Alcohol Related Birth Defects (ARBD) and Alcohol Related Neurodevelopment Disorder (ARND), learning disability
- Alcohol hospital admissions and alcohol mortality are more common in men.
- National data suggests the proportion of increasing and higher risk is greatest in the 45-64 year age range whereas local data suggest it is greatest amongst 16-24 year olds.
- National and local data indicates that drinking at higher risk levels is more common amongst people from Lesbian, gay, bisexual and transgender (LGBT) groups than the general population.
- National and local data indicates that drinking at higher risk levels and binge drinking in greatest in people of White British and White (not British) ethnicities.
- Increased deprivation is associated with increased alcohol-related mortality, but groups of higher deprivation report lower levels of consumption.
- Alcohol use is positively associated with mental illness and 45% of people dependent on alcohol have mental health problems.
- Local survey data does not show a positive correlation between alcohol consumption risk category and poor mental wellbeing.
- Area 4 of the city (Arboretum, Radford & Park, Dunkirk & Lenton) has the highest proportion of people reporting they drink at increasing and higher risk levels and binge drinking.
- The rate of alcohol related hospital admissions in the city has increasing since 2009/10 and is now higher than the national, regional and core cities group. This increase is driven by an increase in alcohol specific admissions.
- Wards with the highest rates of hospital specific admissions are Bulwell, Dales, Arboretum, Basford and Berridge wards.
- Alcohol-related ASB accounts for 18% of all ASB calls to the Police and peaks during summer months.
- The alcohol related violent crime has reduced between 2008/9 and 2012/13 however, in the latest reporting period Nottingham had the highest rate compared to the ONS comparator local authorities.
- Almost half of alcohol-related crime occurs in the city centre and the north of the city is also over-represented. However, when considering alcohol-related violence against the person only, crimes are much more evenly spread across the city.
- Women are underrepresented in the local drug treatment system.
- There is an apparent gap in engaging 20-24 year old clients who are underrepresented in treatment services.
- Fear, stigma and mental health and failure to recognise a problem were the most commonly cited issues that might prevent someone from accessing treatment services.
- The links between alcohol consumption and deprivation requires further exploration.
Recommendations for consideration by commissioners
- Ensure that alcohol treatment services are designed to reflect the fact that alcohol consumption within the home exceeds alcohol consumption outside of the home.
- Interventions should be commissioned to reduce the impact of alcohol related harm during pregnancy.
- Ensure interventions which aim to reduce increasing and high risk drinking and binge drinking are targeted at groups with the highest prevalence. This includes men, young people, White British and White (Not British) and LGBT groups.
- Target upstream interventions, including restrictions on the supply of alcohol, towards areas with increased levels of deprivation in order to reduce the elevated risk of harm demonstrated within the alcohol harm paradox.
- Interventions to reduce drinking at highest levels should ensure equity of access from Area 4 of the city (Arboretum, Radford & Park, Dunkirk & Lenton). Interventions to reduce alcohol-specific hospital admissions should be targeted at areas with the highest rates which are Bulwell, Dales, Arboretum, Basford and Berridge wards.
- Local Authority and Clinical Commissioning Group commissioners should work together to ensure that there are robust referral pathways between substance misuse services and psychological therapy, mental health and dual diagnosis services.
- Alcohol treatment services should ensure equity of access by 20-24 year old clients and women who are underrepresented in the current treatment model.
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