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ALCOHOL MONITORING SYSTEMS

ALCOHOL MONITORING SYSTEMS. Professor Colin Drummond St George’s University of London. What is the point of alcohol monitoring systems?. Burden of preventable alcohol related harm Economic impact of alcohol related harm Monitoring the impact of alcohol policy

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ALCOHOL MONITORING SYSTEMS

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  1. ALCOHOL MONITORING SYSTEMS Professor Colin Drummond St George’s University of London

  2. What is the point of alcohol monitoring systems? • Burden of preventable alcohol related harm • Economic impact of alcohol related harm • Monitoring the impact of alcohol policy • Alcohol treatment needs assessment • Developing theory/evidence base to inform alcohol policy • Persuading governments to take action

  3. Top 10 risk factors for ill-health in the European Union Anderson et al., in preparation

  4. What causes problems? Acute effects • Impaired judgement • Disinhibition • Aggressiveness • Loss of coordination • Drowsiness • Coma • Alcohol poisoning

  5. What causes problems?Chronic effects • Tissue damage • Chronic effects on the brain • Psychiatric comorbidity • Relationships (inc. marital and parenting) • Loss of employment • Financial problems • Alcohol dependence

  6. Source: WHO, 2004

  7. Methods of monitoring alcohol consumption and related harm • Per capita alcohol consumption • General population surveys • Indicators of alcohol related harm • Hospital admissions • Morbidity • Mortality • Social and criminal justice • Treatment access • Alcohol needs assessment

  8. Pros Closely linked to alcohol related harm Based on national statistics Time series Inexpensive to collect Single distribution theory Cons Unrecorded consumption Overseas Duty free Illicit consumption Assumptions % abstainers Per capita alcohol consumptionAlcohol production+imports-exportsPopulation >15yrs

  9. Pros Measure subgroups Individual level data - associations Greater detail – unrecorded/illicit Harmful patterns & quanitites Harmful consequences Diagnostic categories Cons Cost Under-represented groups Recall Attribution Response bias Response rate Recency General population surveys

  10. Alcohol survey measures • Quantity/frequency • Patterns (binge, regular) • Last week/month/year • Alcohol related adverse consequences • AUDIT questionnaire • Alcohol dependence • Alcohol-related health consequences • Alcohol-related consultations/help seeking

  11. Different questions – different information • 90% males, 80% females drink alcohol (16 and over) • 30% males, 19% females drink above “safe” weekly level (ONS, 2003) • 26% males, 15% females “binge drinkers” 6.4M • 32% males, 15% females “hazardous/harmful drinkers” AUDIT 8-15 (Drummond et al., 2005) 7M • 7% males, 3% females drink above 50/35 units/wk (ONS, 2003) • 6% males, 2% females “alcohol dependent” 16+ AUDIT (Drummond et al., 2005) 1M

  12. Pros Official statistics (e.g. ICD) Consequences rather than causes Not reliant on recall/bias Relatively stable methods over time Strong relationship with consumption Cons AAF Alcohol rarely recorded as cause Reliability of coroner’s verdicts/data collection Variation in bias e.g. policing over time/between countries Indicators of alcohol related harm

  13. Source: WHO, 2004

  14. Indicators of alcohol related harmAlcohol specific measures better • Hospital admissions • E.g. alcohol dependence, alcoholic cirrhosis, alcoholic gastritis • A&E departments • E.g. alcohol related attendances, recent alcohol use, hazardous/harmful drinking, alcohol poisoning • Ambulance statistics • E.g. alcohol related attendances • Coroner’s verdicts • E.g. Alcoholic liver disease, alcohol dependence, alcohol related road accidents • Health surveys • E.g. alcohol related consequences, injuries, consultations • Crime surveys • E.g. alcohol related violence • Primary care databases • Police statistics • E.g. drink driving, alcohol related road accidents, drunk and disorderly

  15. Source: ONS 2001

  16. National A&E studyDrummond et al., 2005 • Funded by Strategy Unit/Dept of Health • Maximum burden of alcohol on A&E departments • Regional variations & relationship to general population measures • 36 randomly selected A&Es in England (18%) stratified by region and urban/rural • 116 researchers, 25 regional coordinators • All A&E attenders between 0900 and 0859hr Saturday/Sunday 28/29 June 2003

  17. National A&E study- Results • Eligible 1789 • Consented 1083 (61%) • ETOH+ 41% • Intoxicated 14% • FAST+ 43% • After midnight ETOH+ 70%

  18. National A&E Study. Drummond et al., 2005 National means: ETOH+ = 42% FAST+ = 43%

  19. National A&E study • Predictors of ETOH+ • Young, white, males, single/divorced, unemployed, living with parents or NFA, frequent attenders (1.6x) • More often brought by police/ambulance • Reasons for attendance • Violent assaults involving weapons, RTA, psychiatric emergency, DSH • Weapons: fists, knives, shoes, glasses • Locations: clubs, pubs, public transport • Correlations with general population data • Male binge drinking r=0.83, p<0.001 • Female binge drinking (ns) • Male weekly alcohol consumption r=0.90, p<0.001 • Female weekly alcohol consumption r=0.93, p<0.001

  20. Needs assessment: DefinitionsNARP - Drummond et al., 2005 • Purpose: to estimate the level of need, demand and access to alcohol treatment • Need: number of individuals in the general population with alcohol dependence who could benefit from an alcohol intervention • Demand: • “potential demand for health service” the estimated number of individuals in England with alcohol dependence who have consulted their GP in a year • “potential demand for specialist alcohol services” (PDSA) the number of individuals who demanded some form of alcohol intervention, which is the number who accessed secondary care services (including general and mental heath hospitals) not necessarily with alcohol as the presenting problem • “actual demand for specialist alcohol services” (ADSA) as the number of dependent drinkers referred to alcohol services. • Service utilisation or access: the number of individuals with alcohol dependence that access specialist alcohol treatment in a year • Gap or Prevalence-service utilisation ratio (PSUR): the number in need of interventions divided by the number of people accessing specialist alcohol interventions.

  21. NARP methodologyDrummond et al., 2005 • Need: Psychiatric Morbidity Survey • Hazardous Drinking: people drinking above recognised safe levels but not yet experiencing harm (>21/14U <50/35U) • Harmful Drinking: people drinking above safe levels and experiencing harm. (AUDIT 8-15) • Alcohol Dependence: people drinking above safe levels and experiencing harm and symptoms of alcohol dependence (AUDIT 16+) • Demand: • PDSA: General Practice Research Database • ADSA: Referrals to specialist agencies • Access: National specialist alcohol treatment agency survey • PSUR: Alcohol dependence/Access

  22. Conclusions • Alcohol monitoring essential part of an effective response to alcohol problems in society • Data gathering is a government responsibility • No one methodology answers all questions: triangulation • Different methods, different costs, information • Indirect indicators are useful if bias constant over time (control indicators) • Measures should be scientifically validated and independently researched • Level of data relies on level of resources

  23. References • Anderson et al., Health Social and Economic Impact of Alcohol, forthcoming • WHO, 2004, International Guide for Monitoring Alcohol Consumption and Related Harm • Drummond et al., National Alcohol Research Project, forthcoming

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