Daily Archives: 08/03/2016

Harmful drinking and dependence: PHE release resource

PHE 2016 harmful drinking resourcesAlcohol Policy UK wrote an excellent summary of the new PHE resources launched in January to support harmful drinking and dependence.  So good that I’m going to share in their entirety 😉

Public Health England (PHE) have released a new resource Health matters: harmful drinking and alcohol dependence – see PDF and links here.

The resource aims to support the ‘commissioning and delivery of evidence based treatment interventions to address harmful drinking and alcohol dependence in adults’, and includes infographics, video, a commissioning toolkit and a local service case study.

PHE say around 1.6 million adults in England have some level of alcohol dependence, many of whom may be suitable for treatment, although this question and much of the content are not explored in detail. As such the resource mainly sets out a broad level overview of the impacts of harmful drinking and main treatment response to addressing dependency. Key stats and issues associated with harmful and dependent drinking are highlighted, including mental health, employment, hospital admissions, health inequalities, key groups, and resources for developing treatment services.

Answering the tough questions?

Certainly championing investment in alcohol services may be considered valid; treatment is an ‘invest to save’ measure for which it can be argued that greater numbers should be receiving it, with alcohol services historically having played second fiddle to the drug treatment agenda. However local commissioners may feel there are many ongoing challenging and complex questions in the development of local systems that meet the needs of a range of harmful or dependent drinkers.

One such area may be how the needs of harmful drinkers with no or low severity of dependence might be better engaged. As part of NICE CG115 released in 2011, it identified that 84% of those with a level of dependency are only ‘mildly’ dependent, yet only 1.13% of this population receive specialist treatment, versus 33.69% with moderate or severe dependence. However such drinkers are unlikely to seek or access specialist treatment, in part because they may be unlikely to consider their drinking problematic, or at least not enough to warrant treatment. Whilst ‘extended brief interventions’ or ‘brief treatment’ approaches in non-specialist settings may be most appropriate, there still remains limited examples or guidance on this issue.

It should be noted that in 2011 NICE CG115 released an exhaustive review of the evidence and a comprehensive series of supporting tools and resources. NICE Quality Standard 11 also directly set out the expectations for local treatment provision. PHE too have since released other resources, most notably self-assessment tools, hospital guidance and JSNA support packs. However numbers in treatment have not climbed significantly, and assessing the impact of such guidance on commissioning practice may be questionable.

On a broader level, the effects of changes to the commissioning landscape and indeed ongoing cuts are still to be navigated. Last year Alcohol Concern’s review of alcohol treatment in England revealed a mixed picture; services may be holding steady for the time being, but challenges were by no means limited. PHE state they will be releasing further resources to help local areas identify and target drinking population needs. On how the picture develops, only one thing may be called with a degree of certainty – it will probably vary depending on where you look.

Thank you James (and Libby!) for a great summary and this video does a great job of explaining it all clearly and succinctly.  I was really struck by the numbers in the top featured image so I’m going to re-iterate them here: