Alcohol Treatment Needs Assessment 2012-2013 1. Introduction
Using the JSNA Support pack for alcohol prevention, treatment & recovery, which presents data from the Local Alcohol Profiles for England (LAPE), this document will describe the extent of health harms associated with alcohol consumption in Rotherham. How Rotherham’s performing against national figures will also be shown, this data is taken from the National Drug treatment System (NDTMS) and relates to clients in England who are in treatment primarily for alcohol misuse.
2. Local Data to reduce Alcohol Related Harm and Comparison Groups
The following 3 sections make data comparisons against a national benchmark and using a nearest neighbourhood approach which groups Rotherham with 15 other areas (‘local’) which are similar across a range of demographic, socio-economic and geographical variables. The data has been divided into 4 equal groups in order to allocate levels of harm.
These are:- ‘least amount of harm’; ‘lower harm levels’; ‘higher harm levels’; ‘most amount of harm’.
Although, locally the measures may be higher than the national figures, locally the actual
‘levels of harm’ are either equal to or lower than the national levels.
2.i. Hospital Admissions due to Alcohol
This is the rate of alcohol-related hospital admissions. Some alcohol-related hospital admissions are specifically caused by alcohol while others are contributed to by alcohol (attributable).
a) Under 18’s hospital admissions (all genders, crude rate per 100000 population)
Locally, Nearest Neighbour Group shows ‘least amount of harm’. This is the same as the National Group. Locally & nationally since 2008/09 the trends have decreased and locally seems to be stable since 2010/11 at just under 43 per 100000 population.
b) Admission Episodes (all genders, directly standardised rate per 100000)
Locally, Nearest Neighbour Group shows ‘lower harm levels’’, National Group shows ‘most amount of harm’. Locally, the admission episodes have risen since 2008/9 from under 2000 per 100000, to over 2200 per 100000, we are above national admission episodes but have a lower harm level.
c) Alcohol attributable hospital admissions-non A&E attendance (all genders, crude rate per 1000 population)
Locally, Nearest Neighbour Group shows ‘lower harm levels’, Locally, the alcohol- attributable hospital admissions have increased since 2008/9 and are currently higher than the national rate at 15.54 per 1000 population, however nationally shows ‘most amount of harm’ associated with alcohol consumption.
d) Alcohol specific hospital admissions (all genders, crude rate per 1000 population) The Nearest Neighbour Group that Rotherham has been grouped with shows that this is indicative of ‘least amount of harm’. Locally, the rate 3.50 per 1000 population is just above
the national rate of 3.15 per 1000 population although nationally shows ‘higher harm levels’
associated with alcohol specific hospital admissions.
2ii. Mortality and Months of Life Lost
The data reflects the level of chronic heavy drinking in the population and is most likely to be found in higher-risk drinkers and dependant drinkers. High rates of alcohol specific mortality and mortality from chronic liver disease are like to indicate a significant population who have been drinking heavily and persistently over the past 10-30 years.
a) Months of life lost males & females 2008-10
Locally, Nearest Neighbour Group shows ‘least amount of harm’. Locally, the rate for males is 8.49 months of life lost compared to nationally 8.8; the rate for females locally is 3.66 months of life lost compared to 4.04 nationally. The National Group, for males & females, the level is ‘lower harm levels’.
Locally and nationally the months of life lost for males is more than double than that for females.
b) Alcohol Specific Mortality (all genders, crude rate per 1000 population)
The Nearest Neighbour Group that Rotherham has been grouped with shows ‘least amount of harm’ for this category. Locally we are higher than the national rate, as we have been since 2006-08. The local rate is 0.11 per 1000 population, and nationally this figure is 0.09, however nationally the level is ‘higher harm levels’.
c) Liver mortality (all genders, crude rate per 1000 population) This relates to deaths from chronic liver disease including cirrhosis.
Locally, The Nearest Neighbour Group shows ‘least amount of harm’. Locally we are slightly higher than the national rate (as we have been since 2006-08), the local rate is 0.12 per 1000 population, and nationally this figure is 0.11, however nationally the level is ‘higher harm levels’. However, the gap between local and national levels is narrowing with local trend appearing to be reducing slightly.
d) Alcohol-attributable mortality(all genders, crude rate per 1000 population)
Locally, Nearest Neighbour Group shows ‘least amount of harm’ for this category. Locally we are just below the national rate as we have been since 2009. The local rate is 0.28 per 1000 population, nationally this figure is 0.29. The National Group show ‘lower harm levels’. Local
& national levels seem to have remained relatively static since 2009.
2iii. Alcohol and Crime
This data reflects the level of crime linked to drinking in the population and is most likely to be found in binge drinkers, higher-risk drinkers and dependant drinkers.
a) Alcohol related recorded crime (crude rate per 1000 population)
Locally, Nearest Neighbour Group shows ‘lower harm levels’ as is the national group.
Locally, the rate is lower than the national group at 5.12 per 1000 population compared to 6.45. Locally and nationally the rates seem to have steadily declined since 2009/10 with them appearing to be static since 2011-12.
b) Alcohol related violent crime (crude rate per 1000 population)
The Nearest Neighbour Group that Rotherham has been grouped with shows ‘least amount of harm levels’ for this category, the National Group is ‘lower harm levels’. Locally, the rate is lower than the national group at 3.31 per 1000 population compared to 4.75. Locally the rate has declined since 2009/10 with it appearing to remain relatively static since 2011-12.
3. Waiting Times
This relates to how long clients waited to access alcohol treatment for the first intervention they received. Ensuring that people with alcohol related problems are seen promptly is key to helping recovery from alcohol dependency.
In Rotherham, 52% of all adults waited less than 3 weeks to start treatment in 2012-2013 out of all clients in treatment during the year. This is 10% behind the national figure.
1% of Rotherham clients waited over 6 weeks to start treatment; nationally this figure was 2%.
4. Demographics and headline treatment figures
The national average age of clients in treatment is 42.3 (for men & women), locally the age is similar at 41.5 (men & women).
The number of Rotherham adults in alcohol treatment in 2012-13 was 591 of which 300 (51%) started a new period of treatment. This compares to 69% nationally.
Where alcohol has not been cited as the main problematic drug, 11% (148) of adults in Rotherham drug treatment cited additional problematic alcohol use as their second or third problematic substance in 2012-13, compared to 22% nationally.
5. Safeguarding
Approximately 1 in 3 of England’s alcohol treatment population has a child living with them at least some of the time.
In Rotherham, 77% of clients in treatment are living with children (under 18 yrs.); this is 25%
higher than the national figure.
22% of Rotherham clients in treatment are parents but do not have children living with them, nationally this figure is a lot higher at 44%.
Rotherham has low data incompleteness in this section, only 1% of Rotherham clients in treatment have not completed this data compared to 4% nationally.
6. Employment
Being in work, accessing education or training is strongly associated with improved recovery outcomes. However, most drug and alcohol users in treatment require significant support to address these needs and get them ready for employment. In 2012-13, 27% of Rotherham clients were in regular employment at the start of treatment, compared to the national figure of 23%. 21% of Rotherham alcohol clients were unemployed at treatment start which is better than the national average figure of 39%, however 31% of Rotherham alcohol clients at
the start of treatment were classed as long term sick or disabled; this is 11% higher than the national figure.
7. Drinking Levels and additional substances
This reports on the number of clients drinking at higher risk levels (for women-drinking more than 140 units per month or 35 units per week; for men-drinking more than 200 units per month or 50 units per week), the number of units consumed in the 28 days prior to treatment and the number of people using additional substances to alcohol.
Drinking at higher risk levels increases the risk of alcohol related disease.
80% of Rotherham alcohol clients were drinking at higher risk levels in the 28 days prior to entering treatment, compared to 75% nationally.
37% of Rotherham clients consumed over 600 units in the 28 days prior to treatment which compares to the national figure of 36%. 23% of Rotherham clients consumed between 401- 600 units prior to entering treatment which is 4% higher than the national figure.
Rotherham was lower than the national figure of 1-200 alcohol units consumed, locally the figure was 11%, nationally 17%.
Rotherham’s performance in terms of other substances used (cited as a 2nd or 3rd drug) in addition to alcohol is lower than the national figures. Additionally using opiates or crack- 2%
compared to 4% nationally; additionally using cannabis 3% compared to 10% nationally; and additionally using other drugs (not opiates, crack or cannabis) 3% compared to 9%
nationally.
8. Compounding issues in the treatment population
Many adults in alcohol treatment experience complex and wide-ranging problems, some additional compounding issues identified may warrant further investigation locally.
24% (139) of Rotherham clients have had 3 or more courses of treatment since 1 April 2008, this compares to 17% nationally; 42% of clients live with children regardless of the parental status of the client, compared to 29% nationally.
9. Residential Rehabilitation
This shows the number of adult alcohol users in Rotherham who have been to residential rehab during their latest period of treatment (as a proportion of the whole treatment population). This type of treatment is appropriate for the most serious cases and 2% of Rotherham alcohol clients attended residential rehab, compared to 4% nationally.
10. Length of Time in Treatment
Rotherham Alcohol clients seem to be in treatment longer than the national average figures and also have more average days in treatment-383 compared to 183 nationally. Also, locally clients seem to be in treatment for least amount of time compared to nationally.
20% of Rotherham clients were in treatment under 3 months, compared to national figure of 39%. 21% of Rotherham clients were in treatment between 3 and 6 months compared to 26% nationally; 27% of Rotherham clients were in treatment between 6 and 12 months compared to 22% nationally; and 32% of Rotherham clients were in treatment over 1 year which is 19% higher than the national figure.
11. Treatment Outcomes
This relates to alcohol clients who completed treatment in 2012-13 and whether they did so successfully and didn’t return back to treatment within the following 6 months.
The Governments alcohol strategy states that increasing effective treatment for dependant drinkers will offer the most immediate opportunity to reduce alcohol-related admissions and costs to the NHS. For alcohol dependency there is no single measure of effective treatment, the outcomes data shows how well the current system is working in treating those who are receiving structured treatment.
Retaining clients for their full course of treatment is important in order to increase the levels of successful treatment completion and reduce rates of early treatment drop out. However, having a high proportion of clients in treatment for more than a year may indicate that they are not moving effectively through and out of the treatment system.
In Rotherham 61% of adults left alcohol treatment in 2012-13, compared to 64% nationally.
Rotherham is behind national performance on successful treatment exits and also has more clients returning back into treatment within 6 months of exiting compared to the national figure.
Locally 59% of all exits did so successfully i.e. either alcohol free or an occasional user which compares to 63% nationally. Locally 36% of all clients in treatment in 2012-13 exited treatment successfully compared to 40% nationally.
31% of Rotherham clients exited successfully between 1/1/2012 & 31/12/2012 and didn’t return within 6 months compared to 36% nationally.
Tracey Liversidge Information Analyst November 2013
