ATS0019

Written evidence submitted by Forward Trust

Trends in alcohol consumption and harm from drinking

The UK is experiencing a devastating alcohol fuelled health crisis.

Recent data indicates that alcohol is now the leading risk factor for death among people aged 15 to 49, with a significant increase in deaths caused by alcoholic liver disease and other alcohol-related problems. Moreover, in the past two years, there has been a 27% rise in alcohol-related deaths. Other disturbing research suggests that alcohol use has been increasing at a faster rate among people aged 55 and over, compared to previous generations in that age group. These alarming trends paint a bleak picture of a society facing a significant wave of alcohol dependency and its associated harm. Although the discontinued ONS reporting on alcohol harm has resulted in a patchwork understanding of scale and trends, whatever measurement you track, all point to a tidal wave of alcohol dependency and alcohol harm. 

Our Taking Action on Addiction Campaign has measured alcohol consumption and dependency trends since the start of the pandemic using an annual You Gov survey of over 2000 demographically dispersed participants. Whilst we recognise the use of polling does not provide concrete primary source, in the absence of national tracking data on alcohol consumption trends and dependency the campaign partners stepped in to understand more about the scale of alcohol misuse in the UK.

The finding from three polls have been consistent and reveal worrying increased trends in consumption during pandemic, with a significant number of people reporting problems in reducing their consumption to pre-pandemic levels and experiencing addiction symptoms and consequences related to increased drinking habits. For many people economic uncertainty and rising inflation has created a downward spiral of addiction after the pandemic – compounding the effect from that period where our polls reported that not only rates of addiction increased, but the severe consequences resulting from these increases, grew significantly.  

Our most recent poll 2022 YouGov poll indicated that 32% of adults in recovery reported to have relapsed into addiction or know someone close to them to have relapsed.

The polls also suggests that 2.1 million people, have increased the amount that they are drinking since the cost-of-living crisis began.

A quarter of those who have increased their alcohol intake have reported problems as a result – ranging from lack of sleep, to work problems and stress. You can read more about this polling on: www.actiononaddiction.org.uk

The estimated cost to the exchequer from alcohol harm is in excess of £27billion, but the long-term cyclical impact on families, children and communities across the country is immeasurable. Evidence suggests that children are living with an alcohol-dependent parent have a 2 -10 fold risk of developing alcohol dependency themselves.  Alcohol addiction, like all forms of addiction is deeply connected to trauma, co-occurring mental health conditions and Adverse Childhood Experiences. We would argue that a failure to measure and track alcohol consumption, dependency and wider health impact on families and children push the harm of the UK’s alcohol crisis beyond estimated figures; moreover, it disables preventative policies such as family interventions from long term systemic funding and research. Finally, the nature of addiction, particularly alcoholism, where consumption and impact will often remain unreported, hidden in private, where shame of the illness means people are unable to talk openly about the problems they are experiencing and therefore limits policies that reflect the true scale of the problem.

Commissioning treatment services

The vast majority of local authority services have integrated drug and alcohol treatment services. It’s rare to see an ‘alcohol only’ separately commissioned service. This presents benefits in terms of economies and efficiency and a more coherent experience for people who have both alcohol and drug problems. However, it arguably comes at the expense of a loss of specialism and more importantly, it means people experiencing alcohol dependency may not reach out to treatment services due to the ongoing stigma associated with these services.

There is an increasing expectation for drug and alcohol services to reach and work with people who are ‘problematic’ drinkers but not (yet) dependent, to raise awareness of the impact of their drinking on their health, and to prevent escalation, a public health approach – this presents a challenge in terms of capacity with the need to reach a large group of people (who may not consider they have a problem or need for support) with limited resources, balancing prevention and brief interventions with the more intensive treatment needed for dependent drinkers. Such limited resources allocated to budgets are getting squeezed – and it would be transformational to consider wider scale support for education and awareness campaigns such as those conducted across mental health in the Time for Change public health campaign. Taking Action on Addiction, a partner led education and awareness campaign, works to plug this gap, but has limited resource in comparison to the scale of the problems we face.

Since 2014 services do have increased requirements to work in hospital teams through roles such as ‘alcohol liaison nurses’, who can work with people who, for example, visit A&E or are hospitalised through alcohol-related behaviour, raising their awareness and linking them to treatment and support; these workers can also train hospital staff on alcohol awareness. This is a positive development. This would be improved further if liaison clinicians were better integrated into hospital and primary care systems to achieve better outcomes.

Most recently in service specifications, and in response to the Government’s From Harm to Hope strategy, greater emphasis given to the need for ‘recovery-orientated’ services - supporting people to achieve abstinence as well as and not in opposition to harm reduction - and to support the creation of recovery communities, supported in some cases by structured day programmes (the community equivalent to residential rehabilitation). Forward Trust experience is that day programmes and recovery communities draw alcohol clients especially, who respond well to group dynamics and settings, more so than opiate clients.  

In all while Harm to Hope has been an important milestone for drug treatment services the same cannot be said for addressing alcohol harm and addiction. The missed opportunity to review alcohol treatment and support system is disappointing. Given the scale and complexity of the challenge, the wide-ranging impact on families, children, long term health and society from alcohol harm in the UK the current system is not responding at the scale and impact needed.

Setting and measuring outcomes

In approving the enhanced levels of expenditure on the substance misuse treatment system, Ministers and the Treasury have rightly sought clearer demonstration of the outcomes achieved by this investment.

 

 

One of the outcomes agreed by ministers was that the treatment system would deliver:

-          24,000 more people in long-term recovery from substance dependence.

While this is not particularly ambitious target across a treatment system with almost 300,000 clients, it is a useful way to phrase the key objective of helping individuals to overcome their addictions and is particularly relevant for those with alcohol dependency.

But it is unfortunate that this objective has not filtered down with sufficient clarity to the local commissioning systems. There has been no attempt to hold local partnerships or service providers accountable for the number or proportion of clients who are helped into long term recovery, which is leading to a certain amount of complacency as the new money arrives.

For people entering an established treatment system, indicators of achievement can be created, using data sources already available, to track achievements locally against this objective. It’s imperative that this is implemented, alongside the wider recommendations that alcohol specific goals are responded to.

In reality, there remains a culture of suspicion around long term abstinence-based recovery and funding of residential addiction treatment services. Whilst abstinence may not be wanted by some people, it is a clear and important avenue that should be open to anyone who asks for it. Without considered outcome measures funding will continue to trickle into recovery-based treatment, whether day-programmes or residential. Tracking long term outcomes of existing and any future alcohol treatment system will enable providers to examine the required level and quality of intervention that enables people to move forward and recover from an addiction.  We would be happy to discuss our ideas of what these could look like with the committee.

February 2023