Control of Alcohol in Tower Hamlets

Background

In the United Kingdom, alcohol consumption led to over 31,000 deaths in 2011. The UK National Health Service spent an estimated 3 billion pounds in 2010/2011 for treating alcohol related illnesses and disabilities. Alcohol consumption was the main cause of approximately 10% of disabilities which included 15% male and 4% female.

Tower Hamlets is one of the most deprived boroughs in the United Kingdom. According to 2011 census, Tower Hamlets is revealed as a multiethnic borough, with low levels of home ownership, problems of overcrowding and high level of unemployment (Tower Hamlets Health & Lifestyle Survey, 2011). Alcohol abuse has been a major concern for the UK health policy makers. The white population is estimated to be 50% of the population and 33% Bangladeshis. Taking into account ethnic minorities in Tower Hamlets is specifically important given messages from the Government and alcohol abuse research (Gray, 2012).

During the 2011 population census it was noted that 7.6% of the total population in Tower Hamlets was aged 65 and over which was estimated to be 18,890 people. The distribution of the population varies substantially across different age groups (Tower Hamlets Health & Lifestyle Survey, 2011). Research shows that the population in the range of 20 years represents 59% and are Asian of Bangladesh origin. The survey also shows people in the range between 20-64 represent 25% while those of 65 years and above represent 22% of the population (Tower Hamlets Health & Lifestyle Survey, 2011).

Research shows that Tower Hamlets has less than the highest proportion of households with three or more children under the age of 16. On the other hand, the census report shows that 21% of the 20 age range population in Tower Hamlets is white increasing to 60% of the 20-64 age range population. The Somali population represents 2.3% to 3% of the entire population in borough (Tower Hamlets Health & Lifestyle Survey, 2011).

According to the Government’s index of deprivation, in England, Tower Hamlets represents one of the highest deprived localities in the UK. According to the UK Government statistics, 28% of the population living in Tower Hamlets are not qualified for official jobs (Tower Hamlets Health & Lifestyle Survey, 2011).

According to Tower Hamlets Borough Profile (2012), 45 % of the population is described as welfare borderline compared to 13% of the whole of London. The borough is top in the UK councils as a result of poor healthcare and alcohol abuse. The basic health in Tower Hamlets is much lower than in other cities (Tower Hamlets Borough Profile, 2012). In 2007, Tower Hamlets had the third highest ratio of mortality among men.

The NHS Information Centre for Health and Social Care (2010) approximated that 14.8% of the national population consumed alcohol during 2003-2005. This was equivalent to annual expenditure of £95 million per annum on specialized alcohol disorders treatment. It is important to note that approximately 1.2 million children are affected by parental alcohol issues. In 2001 Tower Hamlets recorded the highest deaths rate related to alcohol estimated at 24 per 100,000 while London had 17.6 and England and Wales has 14.7 as a whole. Males in the borough had upper rates of alcohol related deaths compared to females.

Presently the UK Department of Health (DoH) offers quarterly and yearly admission trends for NHS Tower Hamlets against aliments related to alcohol. These data reveal active tendencies in alcohol interrelated infirmity and offer a benchmark in which NHS Tower Hamlets can gauge delivery of the pointer. It therefore entails section of PSA goal of reducing harms resulting from alcohol abuse (NHS Tower Hamlets, 2013).

The recent data collected between 2009 and 2011 indicate high levels of hospital admittance for alcohol linked harm in Tower Hamlets. This is worse than the entire England equivalent data which stand at the rate of 1,732 per 100,000 populations. This implies that there are estimated 2,712 alcohol related hospital admissions in Tower Hamlets between 2009 and 2011. The need to control the increase in a number of individuals with alcohol related addictions in the borough is vital.  

Between 2005 and 2011, Tower Hamlets experienced the 13^th most months of life lost to alcohol related illness with 10.3 months. The borough has a higher rate of hospital admissions for alcohol related harm than the rest of England (Tower Hamlets Borough Profile, 2012).         

In 2010 the United Kingdom Department of Health (DoH) noted that an estimated £197 were used on each dependent drink compared to £1,744 for each dependent drug user. The DoH (2010) further indicated that alcohol abuse affects 4% of the population in Tower Hamlets. According to the technical document published by Tower Hamlets Substance Misuse Strategy 2012-215 (2012), alcohol misuse leads to bigger harm in the context of both the person and the society at large. The document further established that alcohol abuse is linked with half of domestic violence and assaults in the borough. Research also shows that 15% of hospital admissions are alcohol related and one in five general hospital beds are occupied with patient with alcohol related issue in Tower Hamlets (Tower Hamlets Substance Misuse Strategy 2012-215, 2012).

According to Tower Hamlets Substance Misuse Strategy 2012-215 (2012), the local data of drinking patterns in Tower Hamlets portray an interesting picture related to quality of life and health in the borough. Research shows that despite that alcohol drinking rates are low in Tower Hamlets due to the high presence of Muslim population who do not consume alcohol, there is a high risk of drinking within the population who consume alcohol. Another important picture drawn from recent statistics indicates that 43 per cent of individuals who consume alcohol in Tower Hamlets have dangerous drinking trends.

The third most important trend is that three in ten of Tower Hamlets children had an encounter with alcoholic drink as compared to 7 in 10 in England. This implies that there is a large Muslim population in the borough. Statistics indicate that although there is low prevalence locally of alcohol use, a rate of 1,841 per 100,000 alcohols associated hospital admissions was recorded between 2009 and 2010. In London there was a rate of 1,684 and 1,743 in England within the same time. Research also indicates that above 600 grown up patients were admitted to alcohol treatment services between 2010 and 2011. The research further indicated that an estimated 120 people from the entire population in the borough were on treatment as a result of alcohol abuse, a number which represents 54% in the year 2010-2011. 

According to the technical document Tower Hamlets Substance Misuse Strategy 2012-215 (2012), between 2010 and 2011, there were 1356 brief interventions provided by the Drug and Alcohol Outreach Team in collaboration with Tower Hamlets Enforcement Officers. It is significant to note that there are gaps in data capturing deaths as a result of alcohol. The second gap is associated with prevalence of poly-drug users in Tower Hamlets. There is no sufficient data showing alcohol related accidents in the borough.

Migrants, according to the research, are mostly likely to be drinkers than non-migrants. Migrants, therefore, represent 68% of drinkers compared to 46% of non-migrants in Tower Hamlets. The research also shows that 51% of the migrants are involved in intensive drinking to destructive levels compared to 34% of inhabitants in Tower Hamlets. In Tower Hamlets research shows that harmful alcohol abuse is common to the employed who represent 30% as compared to unemployed who account for 9%.

Intervention Strategies

There are various intervention strategies which can be used to control alcohol abuse in Tower Hamlet borough. The strategies include prevention and behaviour change, treatment and enforcement as well as regulation.

Prevention and Behaviour Change

In the research Lowinson (2010)noted thatprevention and behaviour change is effective in reducing alcohol abuse. The prevention intervention is used in multiple treatment contexts. Young people below the age of 17 should be offered motivational support in Tower Hamlets. The prevention and behaviour change strategy in Tower Hamlets should encompass adult’s check-ups, professional advice besides being offered motivational support. In a research conducted byTower Hamlets Substance Misuse Strategy 2012-215 (2012), out of eight people who receive alcohol advice within the borough, one person reduces his level of alcohol intake to reach the lower risk levels recommended by physicians. Brief advice can reduce alcohol consumption to over 20% in Tower Hamlets (Lowinson, 2010).  Alcohol control through avoidance methods should be embraced and aligned with the needs of the patients.  

Treatment

Treatment is an important part of alcohol control intervention strategy. In the year 2010/2011 the criminal justice system indicated that 49% of the total offenders in Tower Hamlets had an alcohol problem. Between 2010 and 2011a sum of 1356 interventions were offered by Drug and Alcohol Outreach team (Tower Hamlets Substance Misuse Strategy 2012-215, 2012). The interventions provided general harm reduction advice. The current data available from 2009 to 2010 indicate that 13,814 adult patients were diagnosed for alcohol problems in GP surgeries.

During the same period the Tower Hamlets Substance Misuse Strategy 2012-215 (2012) paper shows that 130 adults within the borough finished community detoxification while 83 patients were offered inpatient detoxification. The Tower Hamlets Substance Misuse Strategy 2012-215 (2012) paper indicates that 117 young people with alcohol related aliments were treated between 2010 and 2011. This represents 54% of the young people involved in substance abuse. The paper further indicates that 66% of those whole received alcohol related treatments in Tower Hamlets were males.    

Enforcement and Licensing

Tower Hamlets recorded 309 visits to licensing bodies between 2010 and 2011. The technical document Tower Hamlets Substance Misuse Strategy 2012-215 established that 14 licenses were accepted by trading bodies in the borough while one was revoked.  It was noted that one premise was shutdown for 48 hours because of selling alcohol to underage people. During the same period the paper indicates that eleven written warnings were given and two prosecutions are ongoing. In the Tower Hamlets borough, Tower Hamlets Substance Misuse Strategy 2012-215 indicated that one fixed penalty notice was served for selling alcohol to underage people.  

Within the UK system of licensing laws is best known for restricting the number of outlets selling alcohol. Other control mechanisms include increasing taxation, restrictions on advertising, greater enforcement of the laws and national media campaigns (Ewles, 2005). Ewles (2005) also noted that domestic violence related to alcohol use in Tower Hamlets borough is a major problem which requires law enforcement and regulation. Research conducted by DoH (2011) shows that police deals with 11 occurrences of domestic violence related to alcohol abuse in Tower Hamlets. Another research conducted by British Crime Surveys indicates that 44% of domestic violence in Tower Hamlets occurs under the influence of alcohol (Moyer, 2002).

Aim

To evaluate alcohol prevention and intrusion methods

Methodology and Search Strategy

A search was carried out on the COCHRANE library, MEDLINE and CINAHIL databases in May 2013. The COCHRANE library database was searched using the terms: alcohol, control, adult, prevention, behaviour, change, violence, domestic, intervention, treatment, enforcement, licensing, detoxification and intervention. The same terms were used for the searches on MEDLINE and CINAHL.

Eighty seven records were retrieved through COCHRANE library database, CINAHL retrieved 32 records while 25 records were retrieved using the MEDLINE database. The search from the three databases retrieved 144 records related to alcohol control and intervention strategies. The search looked for titles and abstract of the records retrieved from the three databases. This method noted that 102 records were inline with the standard. The records in addition were examined to determine weather they were within the boundaries of the study.

Inclusion criteria included such requirements as reporting alcohol intake in a manner that could be converted to grams of alcohol per day and as reporting data from an original cohort or case control study. Other factors in the inclusion criteria include records published in English, studies published from 2000 up to date, research records carried out in developed countries.

Exclusion criteria includes items such as reports that were published only as letters to the editor or abstracts and studies that had implausible results. Other factors considered in the exclusion criteria were studies conducted in developing countries, studies published before 2000, records related to women, records for children below the age of ten years.

After applying the inclusion and exclusion criteria, 36 records remained. Eight papers were excluded because they did not address alcohol intake and intervention across different age groups, sixteen records were excluded on the basis that they did not put into consideration active drinking during the six months prior to study enrolment. The four records did not address adults and adolescents (16 years or older) admitted to general inpatient hospital care for other reasons than specifically for alcohol treatment and received brief interventions. Four records were finally excluded because they were descriptive studies or case series and not interventional studies.