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'Alcohol misuse is the most daunting of public health challenges'

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Joint chief executive at the Centre for Mental Health Sean Duggan examines the challenge ahead for the NHS in tackling alcohol misuse.

At the start of the year, which will see the creation of Public Health England as well as far-reaching changes to the NHS, the size of the task each faces in relation to alcohol misuse is staggering. Almost a quarter of the adult population of England are hazardous drinkers, while six per cent of us are dependent on alcohol. Some three-quarters of incidents of domestic violence are linked to alcohol misuse as well as half of assault cases and 63% of woundings.

The cost of alcohol misuse is some £23bn, more than £3bn of which is borne by the NHS. Yet neither health nor drug treatment services are responding adequately to the needs of offenders who misuse alcohol. A window of opportunity to help them to manage their use of alcohol is missed and the risk of further offending is not mitigated.

As with many other health issues, prevention is key and the management of problems should be stepped: from basic advice to those with the least serious issues to more specialised responses to those whose problems are more serious or entrenched. Yet for offenders who misuse alcohol, the responses at all of these levels are woefully inadequate. The absence of support is evident at all levels of need and all stages of the justice system, from first contact with the police to release from prison. The problems of alcohol management for offenders was all too clearly bought to focus during the New Year’s Eve riots in West Sussex.

Offenders have told us that their alcohol problems have been ignored by frontline workers to the extent that some are forced to lie about or exaggerate illegal drug use to get any kind of help. Health and criminal justice commissioners struggle to find common ground on which to fund joint services, hindering the development of effective responses to meet different levels of needs. There are examples of excellent local initiatives, many of them led by enterprising individuals or user groups, but many exist on a shoestring.

We need action on at least three fronts. Alcohol should have parity with illegal drugs in the provision of services to support offenders. We need a range of responses, from ensuring that all health and justice frontline workers are skilled in identification and basic advice to supporting people on community sentences with an alcohol treatment requirement as an alternative to prison.

Health services need to work with the police, prisons and probation to achieve this, building alliances with community and voluntary organisations that have developed creative responses to need and listening to the views of offenders about the support they require.

Finally, we need a renewed focus on prevention. Minimum or unit pricing and regulation of the night-time economy are important ways of reducing risk and preventing offending that should not be overlooked for their potential to improve public health.

Alcohol misuse should no longer be a label for exclusion from health services. The NHS has a key role in reducing the devastating impact of alcohol misuse and offending on all who are affected by it. Instead of picking up the pieces, health services can take the lead and cut the costs to individuals and communities alike.

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