- Introduction
- Alcohol as the default
- Alcohol and the economy
- Alcohol consumption types
- Alcohol impacts
- Torbay profile - Bit too much for too long
- Reducing alcohol harms within Torbay Residents
- Recommendations
Introduction
We tell ourselves stories about alcohol. We know the one that says no social event is complete without alcohol. As children we observe the drinking behaviour of the adults around us and these early examples shape our own lifelong relationships with alcohol. Sometimes the influences are direct and easy to trace but often they are less obvious. Young people grow up hearing about parties where people get drunk and wake with hangovers and for many of them that describes a rite of passage into adulthood. Patterns of binge drinking persist in part because those stories continue to be repeated. Even more pervasive is the underlying assumption that everybody drinks unless they have a specific reason not to –pregnancy or being the designated driver, for example.
There is another set of stories that focus on the problem drinker. With alcohol use being so widespread and prominent in social settings, it is easy to blame the individual who does not fit acceptable patterns of drinking for the problems they experience. These stories portray problem drinking as either a failure of character to be punished or a disease to be treated. These stories highlight the individual and the interventions to fix their problem. However, there are predictable patterns to these individual stories if you pay attention to their common themes. Emergency room staff see the same stories play out repeatedly with different people from one day to the next. Police officers on their different beats can swap stories of drunk and disorderly behaviour that are all too familiar irrespective of where they occur. Social workers invariably spot the signs of problem drinking irrespective of the social class of the families they encounter.
The story of alcohol as the universal social lubricant has an important sub-plot – harmful and hazardous drinking. The social, psychological, and physical consequences of problem drinking occur in a context where alcohol is ubiquitous and there is an expectation to partake if the situation requires it. We cannot successfully intervene with individuals and families to manage problem drinking without seeking to address this wider societal context of alcohol consumption.
Torbay’s rates of alcohol-specific hospital admissions and mortality are significantly above the national and regional average. This observation invites questions as to why this is the case. An attempt to explain these statistics by looking only at individual factors seems unsatisfactory. We need to understand why there is a relative concentration of people who have problems regulating their drinking behaviour or are more prone to the harmful effects of alcohol. In the five years between 2016/17 and 2020/21, there in higher hospital admission rates in more deprived areas of Torbay compared to the least deprived areas. Understanding the reasons for this association demands that we pay attention to more complex stories where poverty and alcohol interact to affect the physical and mental health of our residents.
We know that alcohol can cause harm to the unborn child, and it is now accepted that pregnant women should not drink. However, there is a more interesting story about why a given woman would drink during pregnancy. If we are curious to look beyond the behaviour and to explore the multiple factors that influence it, we may have a better chance of changing things not only for the mother and her child but also for the family and wider community. Exploring the stories of under-age drinking can lead to solutions that go beyond enforcement of the law and invite us to address the reasons why these young people drink in the first place. We might identify the factors that predispose some young people to problem drinking in the future. Finally, we may realise that there is a spectrum to harmful and hazardous drinking.
We have made progress in understanding the impacts of alcohol consumption and attitudes are changing but there is more to be done to make responsible drinking the norm in Torbay and to reduce the harms that affect individuals, families, and the wider community. This is the focus of the Annual Report I am making into the health of the residents of Torbay. My recommendations are intended to inform a more positive story about alcohol where the adverse effects are minimised, and we take collective responsibility for promoting more healthy patterns of drinking.
Alcohol as the default
Within the United Kingdom, drinking alcohol is a well-accepted activity for many, and for many adults is an unremarkable, everyday thing to buy and consume. Within our society drinking, is primarily a social activity that facilitates relationships and social bonding that is bound by rules and customs. It is used to both celebrate and console; it is used to relax and wind-down from the day. What is drunk can represent who we are as people or who we aspire to be e.g., drinking champagne, or particular vintages may be used to symbolise status as well as a way of differentiating between generations and genders with certain alcoholic drinks being in vogue at different points in times - Babycham anyone?
There is an increasing trend, particularly amongst under-25s where alcohol is not part of their lives or lifestyle.
In more recent times, alcohol use has been changing in the UK (Fig.1). Since a peak in the mid-2000s, alcohol consumption has been on the decline (Fig. 2), with the most marked reductions being amongst those who report drinking on five days or more each weak. Also, for a myriad of reasons, many choose not to drink at all.
Within this picture there is also an increasing trend, particularly amongst under-25s where alcohol is not part of their lives or lifestyle (Fig. 3). There is increasing evidence that not only are young people less likely to drink, but if they do this is at more moderate levels than previous generations and is likely to continue as they get older [1].
Fortunately, more and more alternatives, such as soft drinks, mocktails, alcohol-free beers and spirits are becoming available that is meeting demand. For those that do drink alcohol, the increasing availability of 0% or low alcoholic drinks is proving to be a welcome choice also[2]. No or low alcohol drinks in addition to soft drinks and mocktails gives people the opportunity to moderate their consumption by incorporating alternatives into their drinking routine, but without feeling that they are missing out.
As well as a change in alcohol consumption since the turn of this century there has been a change in where people drink with a move away from drinking in licensed premises to one where alcohol is bought from supermarkets and other off-license premises then drunk at home[3][4][5].
Further changes were observed during the COVID-19 pandemic. On 23rd March 2020, the first lockdown across the UK was introduced by the Government. This at once changed how people lived and connected with family, friends, neighbours, and those that they saw on a day-to-day basis. Licensed venues such as bars, pubs, clubs, and restaurants closed overnight, so home became the default drinking venue for everyone, regardless of what they had done before. However, off-licences were given ‘essential business’ status which meant they had permission to remain open during lockdown.
The Institute of Alcohol Studies wrote two briefing papers looking at alcohol consumption during the pandemic.[6][7] There was some evidence of increased spend on alcohol in supermarkets, however, this is within the context of the reduced spend in licenced premises and with a background of empty shelves where people stockpiled many items such as toilet rolls it is difficult to draw meaningful conclusions.
Across the lockdown period, regular surveys were undertaken in relation to alcohol consumption by the polling company YouGov, which was analysed by the Office for Health Improvement and Disparities and compared to surveys of alcohol consumption before the first lockdown (Fig. 4).
Fig 4: Consumption of alcohol from before lockdown to November 2021 - England
Source: OHID WICH Monitoring Tool
View the Fig. 4 data in an accessible table format
We need to be sure our understanding of alcohol use does not overly rely on our views or experience of the past
Regarding the patterns of drinking, the survey data from this time showed a mixed picture where, for many their alcohol consumption did not change much. However, for there were significant shifts for a distinct minority at both ends of the spectrum where there was an increase in the reporting (between a fifth and third in both cases) of people saying that they had reduced or increased their alcohol consumption[8]. IAS noted that there was emerging evidence that it was those who were the most frequent drinking who had increased their drinking during lockdown and more people were drinking at higher risk levels.
Interestingly, with pubs and bars no longer being available, new ways to maintain the social side of drinking during this time of lockdown started to be seen with ‘virtual pubs’ of varying types being seen online through video chats or conference calling software such as Zoom.
All this shows that behaviours and views around alcohol societally are ever changing and evolving. Rather than being a static picture of alcohol consumption and abstinence change is happening at both a micro and large-scale level. Such dynamic evolution means we need to be sure our understanding of alcohol use does not overly rely on our views or experience of the past but rather continues to reflect the reality of the present.
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Alcohol and the economy
For the year 2021/22 the provisional figures for duty charged on alcohol was just over £13billion, which is a bit less than double the 2000/01 figure. Wine brings in the most duty, followed closely by spirits, with both seeing the biggest increases in duty raised between 2012 and 2018 (161% and 139% increases respectively).
Torbay has a significantly higher rate of licensed premises than almost all its comparators.
Fig. 5: Premises licenses selling alcohol – Rate per 10,000 adult residents (2012 to 2018)
Source: Home Office Alcohol and late night refreshment licensing
As well as revenue raised through duty on alcohol, there is the alcohol industry itself which is made up of both producers such as brewers and the retailers (licensed and off-licensed). Together these contribute about 2.5% to the gross domestic product of the UK economy and 3.7% of all consumer spending[9]. Around 2.5% of the workforce across the UK is employed in the alcohol industry, although approximately 65% of these jobs are in pubs, clubs, and bars[10], with many being part-time and not as well paid as other sectors in the economy.
Torbay is a premier tourist destination in the UK, with hospitality and leisure being integral to the tourist offer. With alcohol having a key role in the hospitality sector, by default it contributes to the economy of the Bay. When taken as a whole, Torbay has a significantly higher rate of licensed premises than almost all its comparators. However, Torbay’s rate is around half that of Blackpool and three quarters of West Somerset (Fig 5).
Alcohol consumption types
There are certain groups, stereotypes, and myths in our society that informs much of the discussion about alcohol. These benefit exploration.
The young person
Young adults aged 16-24 are less likely to drink that any other age group, however alcohol consumption on their heaviest day of drinking has been found to be higher than all other age groups.
As seen in Fig. 3 previously, the consumption pattern of young people under the ages of 25 has been on the decline, such that the current generation has been labelled as ‘generation sensible’[11]. This challenges some of the common perceptions about young people and excessive drinking.
However, despite this high-level shift, of those who do drink alcohol, reports suggest that by the age of 17, half of all girls and almost two thirds of boys' drink alcohol every week and the levels of alcohol consumption among our youth within the United Kingdom remains higher than the European average[12].
Youth drinking may cause the young person to have trouble at school or even with the law and Children who begin to drink before the age of 14 are at increased health risks[13][14] including alcohol related injuries and alcohol dependency in adulthood[15].
The proportion of school children permanently excluded due to drug and/or alcohol use in Torbay is much higher than the national average
Of the 311,000 suspensions and 6,000 permanent exclusions and from state-funded schools in England during the 2019-20 academic year, 3% and 10% respectively were drug and alcohol related. In Torbay, while the proportion of school suspensions related to drug and/or alcohol use is similar to the national picture (4% in Torbay), the proportion of school children permanently excluded due to drug and/or alcohol use in Torbay is much higher than the national average, with 18% of permanent exclusions being a result of drug and/ or alcohol use. The data does not allow delineation between substances to understand the proportion specifically linked to alcohol alone[16]
Schools are an important part of any young people’s drug strategy, for building resilience, for early prevention, to identify substance misuse and refer into specialist substance misuse services. Being excluded and or suspended from school can have a negative effect on young people and increase their vulnerability to problematic substance misuse.
Fig. 6: Among those who said they drank alcohol, the proportion (%) of adults who exceeded 6/8 units on their heaviest day, by age, Great Britain, 2017
Source: Home Office Alcohol and late night refreshment licensing
Young adults aged 16-24 are less likely to drink than any other age group, however alcohol consumption on their heaviest day of drinking has been found to be higher than all other age groups. Among drinkers aged 16 to 24 years, 37% reported binge drinking on their heaviest drinking day in 2016 compared with just 10% of drinkers aged above the age of 65 years[17] (Fig. 6). This age group remains one of the groups most likely to be drinking harmfully when compared to the rest of the drinking population[18].
The ‘big night out’ has been a long-established feature of young adult drinking, which is often linked with heavy or binge drinking [19] (the UK also has one of the highest rates of young people aged between 16 and 24 indulging in ‘heavy sessional drinking’) and may help to provide some understanding of the context within which to interpret these findings.[20]
The development of mainstream nightlife characterised by large bars, late-night dance bars and commercialised night clubs, occupy youthful ‘playscapes’ or ‘nightscapes’ in volume, with different ‘brands’ targeted at diverse groups within a youthful demographic. When we think about young people socialising in drinking at bars and clubs on a night out, it is worth remembering that regardless of how chaotic they may seem; drunken nights out are in fact structured by norms and rituals – albeit very different ones from the norms and rituals of everyday life. Also, drunken nights out are about small groups of friends rather than individuals, so behaviour must be understood in the context of the group.
Binge drinking
The common, everyday description of binge drinking is consuming a lot of alcohol in a short space of time.
The technical definition, however, is drinking more than 8 units of alcohol in a single session for males, or more than 6 units in a single session for females[20].
While it is only a minority of people who end up in hospital after a heavy drinking session, hospital admission data can be useful in highlighting some extremes in drinking behaviours amongst young people. The data captured for young people (those aged under 18) within Torbay admitted to hospital due to alcohol suggests Torbay’s young people are experiencing greater levels of alcohol related harm compared to the national average. Latest data shows that for Torbay the rate per 100,000 young people being admitted is 72, compared to the national average rate of 31 [21]. On a more positive note, however, the general trend for Torbay (as well as nationally) has been a downward one in number of young people being admitted to hospital for alcohol specific conditions.
Alcohol-related harm amongst young people in Torbay is further seen in the levels of drinking reported by the numbers who are receiving support for their alcohol use. Amongst those young people accessing treatment and support, 18% report consuming between 200 and 399 units of alcohol over a 28-day period in Torbay, which compares with 4% drinking at this level in the national picture of young people in treatment for drug and alcohol problems (Table 1).
| Units | Local (n) | Proportion of young people (%) | Male (%) | Female (%) | England (n) |
|---|---|---|---|---|---|
| 0 | 16 | 50% | 57% | 38% | 4,518 |
| 1-199 | 24 | 44% | 40% | 53% | 3,999 |
| 200-299 | 9 | 4% | 3% | 6% | 353 |
| 300+ | 0 | 0% | 1% | 3% | 162 |
| Total | 49 | 9,032 |
Source: The National Drug Treatment Monitoring System (NDTMS) data provided by the Young Peoples drug and alcohol service, covering the period 1 April 2020 to 31 March 2021 for young people in treatment.
Social Drinker - evolution to dependency
Outside of the hustle and bustle of the ‘big night out’ scenario, and often as people gain more responsibilities the nature and context of drinking is different. Social drinking refers to casual alcohol consumption and can be described as someone who occasionally drinks alcohol at a low level in a variety of social settings. It happens on special occasions and commonly involves one or two drinks in a pub, bar, or restaurant.
To minimise the risk of alcohol-related health harms, social drinkers should be drinking within the Department of Health Guidelines for alcohol
The key distinguishing feature of a social drinker is someone who, despite regular drinking is still able to function without it. Social drinking is common and generally low risk, without causing disruption to someone's life or creating serious physical, mental or personal problems. To minimise the risk of alcohol-related health harms, social drinkers should be drinking within the Department of Health Guidelines for alcohol consumption of drinking no more than 14 units a week on a regular basis for both males and females.
Social drinking
In addition to the term social drinking other descriptors in everyday use such as responsible drinking, sensible drinking and moderate drinking are often used interchangeably.
The principle underpinning these terms is about consuming alcohol at a level that doesn’t harm others and is minimises risk to the drinker him or herself.
This is often viewed as being linked with lower-risk drinking and adherence to the Department of Health Guidelines.
However, it can become a problem if social drinkers start to drink to excess or binge drink. In England, 58% of adults in a national survey [22] reported drinking in the previous week, which was higher than Scotland or Wales. Binge drinking was reported in the South West by almost a quarter. This shows that while many drink regularly but moderately there is a small but significant minority who exhibit heavy episodic consumption within this drinking behaviour.
Multiple social drinking engagements a week can lead to heavy drinking, which in turn increases someone’s risk of health harms and can lead to longer-term problems. Drinking socially, and a borderline alcohol use disorder may be harder to tell apart, but if someone is unable to stop drinking, they may not just be drinking socially, and their use may have developed into an alcohol misuse problem.
Sometimes social drinking can transition into something more problematic when alcohol gets used as an emotional prop. When people feel down, worried, and out of balance in response to life’s struggles and setbacks, the feelings of hopelessness, fear, anger, sadness, or overwhelming stress can begin to interfere with how we function in daily life. For some it can be tempting to try to cope in the simplest way possible, by reaching for a drink. Alcohol is a common method of self-medication, as it is so widely available. However, any benefit is short-lived and in the longer run it only makes symptoms worse. It also, does nothing to resolve the underlying cause.
Regular use of alcohol in this way can lead to psychological and physical dependency, a worsening of mood disorders, and increased health problems. It can also damage important relationships with others[23].
Dependent drinker
In Torbay, it is estimated that there are approximately 1,500 adults with an alcohol dependency. This means that for every 1,000 residents, 14 will be living with an alcohol dependency, which is consistent with what is being observed nationally
Unlike the stereotypes that many people have of someone who has an alcohol dependency. It is common for individuals with a dependency to be successful in their career and held in regard by work colleagues as well as members of their community. They are loved by friends and family and often able to mask their problem. As a result, it can be difficult to identify them, and many live their lives in this way without receiving any help and support until an incident occurs or a health warning triggers the need for them to access treatment. Someone drinking in this way may experience wider problems in their lives such as difficulties in relationships with family members and friends, or in the work that they do as well as possibly their behaviours impacting upon the wider community due to, for example, drink driving, anti-social behaviour of even alcohol-related crime.
In Torbay, it is estimated that there are approximately 1,500 adults with an alcohol dependency. This means that for every 1,000 residents, 14 will be living with an alcohol dependency,[24] which is consistent with what is being observed nationally[25].
Access to alcohol treatment is important for people who have a dependency on alcohol and the number of individuals accessing specialist support within Torbay is good when compared to those accessing treatment nationally. Where nationally, 18% of those with a dependency on alcohol access specialist treatment for this, in Torbay this is almost double, with 34% of those who may benefit seeking help.
Within Torbay we are fortunate to have different types of support available to people struggling with an alcohol problem, including access to fellowship groups, like Alcoholics Anonymous, known as AA where the 12-step principles are applied to support people with alcohol addiction. Individuals can access AA online or face to face, with meetings available in various locations across Torbay[26]. Individuals who may not find the 12-step principles helpful for their recovery or would like to access something in addition also have the option to access SMART (Self-Management and Recovery training) meetings, which supports individuals though a Cognitive Behavioural Therapy (CBT) based approach. SMART groups run face to face in Torquay and are available on-line, with online SMART recovery groups also available to friends and family members of those experiencing addiction, including specific groups tailored just for women and veterans in recovery[27].
Dependent drinking
Alcohol dependence describes a strong and often uncontrollable desire to drink, tolerance to its effects, and difficulties controlling its use and can cause emotional distress to someone if they are not drinking. Someone who is alcohol-dependent may persist in drinking, despite harmful consequences, such as physical or mental health problems.
The Specialist Alcohol Treatment service also offers support to those with an alcohol dependency problem as well as those family members who are affected by a person’s drinking. The service works with someone to identify their personal treatment goals and work together to develop a treatment plan, which may consist of access to a range of psychosocial interventions delivered via groups and/or individually, examples may include interventions to address the root cause of the addiction or group work focusing on developing strategies to help manage urges and cravings and prevent relapse. There may also be the opportunity to access medical interventions to help individuals to detox from alcohol, as well as to manage withdrawal symptoms and to help reduce cravings. This support could be delivered to individuals within the community from their homes or from in an inpatient setting, depending on the individual's personal circumstance. A range of on-line support interventions are also available, including Silvercloud and Breaking Free Online. These online programmes provide the opportunity for individuals to access support in their own home, specifically targeted to help improve mental health and wellbeing, with specific modules for alcohol. Finally, the specialist service support individuals to link into wider community initiatives to help support recovery, which could include anything from helping
individuals get back into employment, to navigate the housing system or access community activities to support the development of new hobbies and friendship groups[28].
The graphs below demonstrate that the Torbay treatment provision is high performing with all key metrics being higher than the national average for 2020/21 (Figs. 7 & 8).
Alcohol within the family
The relationship between consequences of alcohol use and parenting is more marked in Torbay than elsewhere
There are many facets of alcohol in the family unit associated with children, young people, and parents; all of which affects relationships and influences behaviours in different ways. It is well known and recognised that the drinking behaviours of a young person’s friends has a strong role to play in that person’s drinking decisions. There is, however, a lot of evidence[29][30][31] that young people’s drinking behaviours and beliefs are also heavily influenced and informed by their parents drinking, with this starting from a very young age[32][33]. This is even more significant if excessive drinking is a feature of the young person or parent.
As well as parental influence of their children’s drinking patterns for the future, alcohol can also play a part in a parent’s ability to care for their children and keep them safe. It is easy for parents to underestimate the implications of consuming or having consumed alcohol whilst being the sole carer for a young child. How often have parents had ‘a few drinks’ at the weekend and a child in their care has injured themselves? If that child requires immediate medical care and must be taken to hospital this poses not only the challenge of how to get the child there (as the parent may well be over the limit to drive there) but once at the hospital there may be concerns raised if the parent(s) are drunk. What may have seemed a reasonable situation at home takes a quite different turn in this context.
Excessive and regular parental alcohol use can impact on someone’s capacity to parent, negatively affecting children’s health and development
Fig. 9: Alcohol misuse as a factor in Children in Need assessments – Rate per 1,000 child residents (2018 to 2021)
Source: Home Office Alcohol and late night refreshment licensing
Further to this, excessive and regular parental alcohol use can impact on someone’s capacity to parent, negatively affecting children’s health and development. In the most severe cases, parental drinking can result in abuse and neglect of their children as well as inconsistent and unpredictable parenting behaviour. This often involves additional support from health and social care services. Torbay has a higher rate of Child in Need assessments where alcohol is a factor than for England, the South West and our coastal comparators.
The relationship between consequences of alcohol use and parenting is more marked in Torbay than elsewhere in England and is something that warrants particular focus to improve the wellbeing and safety of both children and parents.
Alcohol impacts
As well as the positives alcohol brings to society and the economy, there are also negatives experienced by individuals, families and communities that arise from excessive alcohol use.
Alcohol and health
The World Health Organization[34] states that alcohol contributes to more than 200 diseases, injuries, and other health conditions. This health impact can be acute in nature due to being drunk or as a longer-term consequence of drinking alcohol over time.
These health consequences from long-term alcohol use, however, are not experienced equally across society, or even necessarily according to the amounts of alcohol being consumed. While there are higher death rates for alcohol-related causes amongst the poorest in our society, these groups often report lower average levels of alcohol consumption and vice versa. This is often called the ‘alcohol paradox’. The most likely explanation being that there is a greater impact amongst poorer sections of society due to the wider social, economic and environmental factors that come into play.
Torbay consistently has higher rates of alcohol-related admissions than other places with those living in our most deprived communities being most affected.
In England, alcohol misuse is the biggest risk factor contributing to early death, poor health and disability for people aged 15 to 49 years old[35]. When looking at alcohol admissions where alcohol is a primary contributing factor for the admission, this made up almost 348,000 or 2% of all admissions in England[36]. Torbay’s level of hospital admissions related to alcohol is significantly above these national rates. Fig. 10 shows the extent of difference in hospital admissions rates for alcohol specific conditions relate where one of the diagnoses is entirely linked with alcohol.
Fig. 10: Alcohol specific admission rate per 100,000 (Age standardised) 2017/18-2021/22
Source: Hospital Episode Statistics
While there is an observable difference, this graph also shows admission rates in Torbay during 2020/21 and 2021/22 as falling when compared to the three years previously. When looking at female and male rates there is little to show significant falls in admission rates as the numbers are volatile. When we divide the Torbay population by those who live in areas amongst the 50% least and 50% most deprived in England, admission rates appear to have risen quicker amongst the least deprived 50% during 2021/22.
From this we can see that Torbay consistently has higher rates of alcohol-related admissions than other places with those living in our most deprived communities being most affected. This tells us that the nature of alcohol consumption in Torbay is having a more severe impact upon Torbay’s residents’ health than is being seen either regionally or nationally.
There will be 200,00 alcohol-attributable hospital admissions more nationally than would have otherwise been expected if COVID -19 had not happened.
With the change in drinking patterns observed during the pandemic amongst those two distinct populations at either end of the continuum who either stopped drinking completely or who increased their consumption levels, there is uncertainty as to what this may convert into regarding alcohol-related illness and death in later years. To better understand future drinking behaviours post-pandemic and the health impact of this, researchers at the Sheffield Alcohol Research Group[37], considered five different scenarios about how drinking behaviours may change from 2022 onwards. The most likely scenario assumed that lower-risk drinkers who drank within the recommended guidelines would return to their pre-pandemic levels of drinking quite quickly, while those who were drinking at higher levels than recommended would continue doing so for another five years before reducing to pre-COVID levels within the next five years after that. It was forecast that for this scenario a further there will be 200,00 alcohol-attributable hospital admissions more nationally than would have otherwise been expected if COVID -19 had not happened. In addition to this there will be approximately 7,000 more deaths over the coming 20 years.
It is forecast that this will not be experienced equally across the population, with those drinking the most and those in the most deprived areas being most likely to experience alcohol-related harm and death.
Alcohol and economy
While the alcohol industry in all its guises contributes to the economy, alcohol consumption also has its downsides. The most common cost to the economy is absence from work due to a hangover, with this being most likely in those who drink the most[38][39]. However, it is those who drink more in keeping with the recommended levels who are least likely to be absent rather than those who do not drink at all[40][41][42][43].
There is also the situation where people work while suffering with a hangover which impacts on how well they can do their job even if not taking a day off[44]. The consequence of this is that people’s thinking and motor skills are likely to be compromised which as best means someone is not performing as effectively as they could or should, but in some industries, this may be putting the person or colleagues at risk of injury or even death[45].
When considering the role that alcohol plays amongst those who are unemployed, those who are the heaviest and most at-risk drinkers find themselves being at greater risk than most working age adults of being unemployed[46][47].
Alcohol and crime
Alcohol is a factor in approximately two of every five violent crimes committed in England according to the Office of National Statistics[48], but it is not limited to such serious offences with just under one in five of all recorded crimes being alcohol-related[49]. Furthermore, there is a strong, and well evidenced relationship between alcohol and domestic abuse and sexual violence[50] with alcohol often consumed at the time of assault by a perpetrator. Where severe violence has occurred, this is even more likely to be the case. It is important to state, however, that alcohol is not the cause of violence and abuse but a factor in it.
For 2021/22[51] 20% of recorded crimes in Torbay had alcohol recorded as a factor, this was up from 17% during 2020/21 and 15% during 2019/20 when there were a series of substantial lockdowns. Looking at the period 2016/17 to 2021/22, the proportion of crimes that had alcohol recorded as a factor is higher in the summer months and at Christmas.
Excluding domestic abuse and sexual offences, 38% of recorded crime within Torbay during 2021/22 was classified as violent crime.
Alcohol and public services
As well as the distress caused by alcohol-related crime, alcohol consumption causes additional strain on many public services such as when it is a factor in fires and presentations at accident and emergency departments. It is not only the demand impact, but how people respond to the help being offered with high levels of reporting by emergency services about the abuse that they encounter[52].
Torbay profile - Bit too much for too long
This population are at greatest risk later in life, where they have an increased chance of serious ill-health, multiple hospital admissions, and early
There are people who drink just over the recommended guidelines each week and have been doing so for a long period of time. Like social drinkers, these individuals are unlikely to experience problems related to their daily functioning because of their drinking behaviour, however the long-term nature of their drinking has been shown to develop into health difficulties observed later in life. Recent alcohol statistics suggest that it is those adults aged over 45 who are not only most likely to exceed the recommended weekly drinking limits, but also most likely to drink on five or more days in the week with this being more pronounced in the South West than most of the other regions of England[53][54].
Many are educated and highly functional in their day-to-day life and recognise no harm with consuming just over the recommended weekly volumes of alcohol over a prolonged period. These individuals are likely to hold specific stereotypes with problem drinking and attribute youngsters causing anti-social behaviour/crime and violence or someone who sits on a park bench drinking high strength alcohol as individuals who have the problems with alcohol.
This group of people are often referred to as the hidden population in society. They are unlikely to be viewed as in need of any alcohol support from those around them and will see no reason to change their drinking behaviours or access support. Sadly, this population are at greatest risk later in life, where they have an increased chance of serious ill-health, multiple hospital admissions, and early death[55].
For Torbay, the evidence points to there being a large number of people in this category given hospital admission episodes for alcohol related conditions are currently at 599 per 100,000 per population[56]. This means there are a high number of people who are unknowingly causing gradual harm to their health, because they are drinking a little too much, too often, over decades.
The impact on our health services should also be considered here, with the increasing numbers of individuals requiring hospitalisation and medicalised intervention for their alcohol use, this can contribute towards the increasing delays and wait times for medical care to be received within the community.
The collective challenge is in helping people to identify if they are drinking in this way which is where awareness raising and using evidence-based alcohol screening opportunistically and at scale will enable people to modify their drinking.
Responsible drinking
Sitting at the centre of both the issue and solution is the concept of responsible drinking and drinking within the recommended guidelines. In 2016, the Chief Medical Officers across the UK updated the responsible drinking guidelines which moved away from a weekly recommendation to a daily one. The advice for both men and women is:
- To drink no more than 14 units a week on a regular basis.
- If you regularly drink as much as 14 units per week, it is best to spread your drinking evenly over 3 or more days.
- If pregnant, the advice is to not drink alcohol at all.
Drinking at home has a strong link with excessive and harmful drinking behaviours
Underpinning this advice is the concept of alcohol units (Fig. 11). The definition of a single unit of alcohol is 10mls of pure alcohol which is the amount that an average adult’s body can process in one-hour. With drinks varying in their strength and volume (a pint of lager compared to a shot of vodka) units allow comparisons to be made between them. Most drinks contain 1-3 units of alcohol.
Fig. 11: What 1 unit looks like
Source: Drinkaware
View the Fig. 11 data in an accessible table format
While most people know that the measurement of alcohol is units[57], and surveys show that most people have heard of responsible drinking levels at a general level, only a minority know these in a way that they would be able to apply the recommendations. Very few people report keeping track of the number of units they drink to inform their drinking[58][59].
This is further complicated when considering where people drink. With 65-70% being bought from supermarkets and other off-licences compared to only 30-35% of sales in pubs, clubs and restaurants [60], there can be a mismatch between measures. While drinks in licensed premised are sold in recognised measure e.g., a single shot of vodka will be one unit of alcohol, this is not necessarily the case at home. This means that understanding and sticking to recommended guidelines can be a harder task than it may first appear. In the first instance, it is necessary to understand what a unit of alcohol is; secondly someone must apply this knowledge when pouring a drink. Thirdly there is a need to monitor how many units have been drunk in a single session as well over several days. Finally, someone must be willing and able to drink within the recommended limits.
Consciously measuring and monitoring alcoholic drinks at home is key to drinking within the recommended guidelines
With most drinking taking place in the home, and the norm being characterised as a combination of liberal measures and unmonitored consumption it is unsurprising that home drinking has a strong link with excessive and harmful drinking behaviours[61][62]. Against this background, consciously measuring and monitoring alcoholic drinks at home are key to drinking within the recommended guidelines. Helping people not to ‘overpour’ or under-estimate alcohol content when drinking at home, is essential.
A Holiday from Alcohol
Another useful strategy that helps some people who are drinking a bit more than is recommended, (but who are not dependent on alcohol as this can be dangerous) is taking a break from alcohol for a period. Alcohol Change UK’s ‘Dry January’ programme is a widely known campaign that is based on this concept. People choose to take a break from alcohol by not drinking for the month of January.
The benefits of not drinking, or having a holiday from drinking for a while, are broad ranging. From the obvious of feeling better as alcohol can take a bit of a toll on your body as it tries to process it through the body. Some of the other up-sides people who have done this talk about are:
- Saving money.
- Helping with in any weight loss intentions as alcohol is full of empty calories.
- Better quality of sleep, which means feeling better in the mornings and more energetic during the day.
- Improvements in relationships if alcohol has got in the way a bit.
- Improved mental health as alcohol can worsen people’s mental wellbeing.
Reducing Alcohol harms within Torbay Residents
In summary, many of the key features of Torbay’s alcohol profile are no different to those seen nationally. However, there are other aspects that are unique to the Bay and require further focus and response (Table 2).
Table 2: Torbay’s alcohol profile compared to the national average
Torbay comparable to national average
- Beverage preferences
- Profile and trend of the different age groups in the population who drink and abstain over time
- Rates of adults with and alcohol dependency.
- Heavy drinking profile across age groups and between men and women
- Presence of a range of independent alcohol support options such as AA.
- The lockdowns associated with the pandemic and changing drinking profile will most likely result in higher morbidity and mortality than if Covid-19 had not happened.
- The impact of alcohol on attendance and productivity at work
- The burdens on many public services from alcohol use.
- The proportion of school children whose suspension is related to drug and/or alcohol use
- The role alcohol plays in criminal activity
- The dominance of drinking in the home compared to licensed premises
- The awareness of and drinking within the recommended limits of alcohol consumption
More common in Torbay
- Higher numbers of licenced premises.
- Higher proportion of people with an alcohol dependency who access alcohol treatment.
- Accessible formal treatment support that performs highly
- A treatment offer that is acceptable to females
- When Children in Need assessments are undertaken, alcohol is a more prevalent factor impacting upon parenting.
- Higher rate of young people admitted to hospital due to alcohol-related harm.
- The proportion of school children permanently excluded due to drug and/or alcohol use
- A higher level of alcohol-related hospital admissions with those living in the most deprived communities being most affected
While there is often an assumption that young people and alcohol dependency have the greatest impact in Torbay, the reality is more nuanced. For young people the overall general trend is away from drinking alcohol when compared with previous generations, but problems with alcohol for this smaller number of young people who do drink is often more complex and impactful. Alcohol consumption within the family for a small but distinct number is adversely affecting the development and safety of children.
For those with an alcohol dependency there is access to a range of support provisions from self-help groups such as Alcoholics Anonymous or SMART Recovery through to community treatment and residential rehabilitation. Not only are these available but we know they are very effective in what they do in Torbay, with many people choosing to get support for their dependency.
The greatest difference, as far as the numbers of people affected, goes is around those who drink a bit more than they should, for a bit longer than they should. It is this population group that are most often being seen in hospital due to alcohol-related health difficulties. Central to any approach here is education and support at national and local levels.
At a national level there are campaigns where larger media platforms like TV and Radio can be used to help raise awareness at scale, not only within Torbay but to the general public on a national footprint. National campaigns like alcohol awareness week and Dry January are great opportunities for public health teams and partners to raise awareness of the longer-term harms associated with drinking slightly too much for too long, using social media platforms as one method of engaging this population.
At a local level, it is about involving residents to help us understand what people think, how best to share information and what approach will be most meaningful and be of greatest benefit to make those small changes in drinking behaviour that will improve people’s health over time.
Recommendations
- Recommendation 1
- For local premises to celebrate responsible drinking by offering and promoting no and low alcohol options
- Recommendation 2
- Further build on partnership working to use internationally endorsed alcohol screening tools to help people understand if their alcohol consumption is putting them at risk and providing the information and advice to make any necessary changes that may be identified.
- Recommendation 3
- Promoting collaborative working between statutory and voluntary bodies to identify those children, young people and families most at risk and supporting them to make changes to their drinking.
- Recommendation 4
- Gaining a fuller understanding of the role of alcohol in permanent school exclusion and what can be done.
- Recommendation 5
- Encouraging the use of bar measures such as shot or wine measures in the home and alcohol tracker apps like the free ‘MyDrinkaware - Alcohol Tracker’ app to help people monitor their intake accurately.
- Recommendation 6
- Promoting the support offers for those with an alcohol dependency and their family members available in Torbay.