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The level of need in the population

Background papers: Lifestyle and wider determinants :: Alcohol [Update in progress] :: The level of need in the population

The key findings from the National Alcohol Health Needs Assessment Research Project (ANARP) showed that 26% of men and women (aged 16–64) had an alcohol use disorder. In England, 23% of the adult population are classified as hazardous or harmful drinkers. The annual number of alcohol related deaths more than doubled in the UK between 1991 and 2005 from 4,144 to 8,386 (ONS, 2006). Death rates are more than twice as high for men than women.

Applying the ANARP findings to the Medway Population the following estimates can be made about the level of need.

  Percentage of
adult population
Estimated numbers
of ‘problem’ drinkers
Harmful drinkers 5.2 10,384
Hazardous drinkers 19.3 38,542
Binge drinkers 16.1 32,151
Dependent drinkers 5.9 11,782
Moderate dependence 0.4 799
Severe dependence 0.1 200
Table 1: Estimated numbers of adults with drinking problems in Medway
(Based on 199,700 adults)

DH guidance states at least 15% of dependent drinkers should be able to access services.[1] In Medway services should therefore have capacity for around 1,800 service users.

ANARP and DH equate the need for a service with dependence. This is not to say that specialist alcohol services do not have a role with harmful, hazardous and binge drinkers, but this role should probably be confined to educating and supporting tier 1 providers (such as GPs and other health staff) in the appropriate competencies and interventions such as IBA. Findings from the ANARP showed there were low levels of formal identification, treatment and referral of patients with alcohol use disorders (AUD) by GPs. Of those identified as needing specialist treatment many were not referred due to difficulties in access and patient preference not to engage. In the South East only 1 in 20 in-need alcohol dependent clients were accessing treatment.

Alcohol related hospital admissions

In 2008 the alcohol-attributable admission rates for Medway Local Authority were significantly lower than the regional and national level. However the 2011 Local Alcohol Profile[2] shows that there is now no significant difference between Medway and England. The rate of admissions to hospital for alcohol in Medway rose by 9% between 2008/09 and 2009/10. This was a higher than the previous year of 4%, but still in line with the national aim to reduce the rate of increase of alcohol-related hospital admissions (ARHA). The ARHA indicator is complex. It includes all those admissions that are specifically due to alcohol such as alcoholic liver disease, but it is made up mainly made up of admissions where alcohol may be a contributory cause. For these where alcohol is a contributory cause, a calculation is applied which relates to the proportion of cases that are likely to be caused by alcohol according to scientific literature. So, if 60% of pancreatitis is considered to be caused by alcohol, for each admission to hospital for pancreatitis, this would count as 0.6 of an admission.

Figure 1: Alcohol related age standardised admission rate
Figure 1: Alcohol related age standardised admission rate

Regionally Medway Local Authority has the 16th highest admission rate out of 67 local authorities. In Medway alcohol specific mortality for women has increased significantly since 2004 on par with regional and national levels. Male specific mortalities also follow national trends and are significantly higher than for women. Under 18s rates of admission have dropped slightly in line with national trends.

Dual Diagnosis

UK data generally show that:[3]
• Increased rates of substance misuse are found in individuals with mental health problems affecting around a third to a half of people with severe mental health problems
• Alcohol misuse is the most common form of substance misuse
• Where drug misuse occurs it often co-exists with alcohol misuse
• Homelessness is frequently associated with substance misuse problems
• Community Mental Health Teams (CMHTs) typically report that 8–15% of their clients have dual diagnosis problems
• Prisons have a high prevalence of drug dependency and dual diagnosis.


[1]   Department of Health. Signs for improvement - commissioning interventions to reduce alcohol-related harm 2009;
[2]   North West Public Health Observatory. Local Alcohol Profiles for England 2010;
[3]   Crawford V, Clancy C, Crome IB. Co-existing problems of mental health and substance misuse (Dual Diagnosis): a literature review Drugs:Education, Prevention and Policy 2003; 10 (Suppl.): pp.S1-S74.