Director of Public Health Annual Report 2019: Alcohol and us
Impact of alcohol on families and communities
Alcohol can have harmful health and social consequences not only for the drinker but also the people around them and wider society. Misuse of alcohol can have a powerful harmful impact on families, including financial problems, parenting difficulties, children missing school, family breakdown, child abuse and neglect and family violence. There is also an increased risk of accidents and injuries, involvement in violence and risky sexual behaviour.
The misuse of alcohol by parents can play a role in making some families less stable. When a parent overdrinks there may be arguments in the family or less money to buy the things the family needs; this can mean the children have poorer health and wellbeing. When parents misuse alcohol, their marriages are more likely to end in divorce.
Alcohol impact on other family members - A Buckinghamshire view
The Prevention Matters is a free and friendly advice service linking eligible adults (over 18) in Buckinghamshire to social activities, volunteers and community services.
Prevention Matters is delivered by Connection Support on behalf of Buckinghamshire Council.
Prevention Matters support includes the following:
- Help to get back into work, accessing Job Clubs and Job fairs.
- Support with loss of confidence/isolation.
- Access to community groups/activities.
- Access to a range of local support to include learning new skills/improving health.
- Referral into other organisations that can offer more specialist support i.e. One Recovery Bucks, AA
"Some of the people who Prevention Matters support with an alcohol addiction have found that they don’t want to be drinking. They are drinking because something traumatic has happened in their life, like a relationship breakdown, redundancy, or the loss of a child or a parent. Our clients come from differing backgrounds and drinking has become their way of coping with the difficulties faced in life.
We find that some people become really angry with their partner’s drinking, others say ‘I can’t do this anymore, I cannot continue to live like this’. Some are very supportive but when their loved one doesn’t fully engage with the help available, they are often left feeling like the drink is more important than they are. This can lead to breakdowns within the family, which causes increased drinking.
The effects of a family member drinking can effect the amount of income available for daily expenses. This can mean the family risks eviction, and they might not even be able to afford the basics like food, heating, lighting and clothes. Drinking can also lead to concerns by professionals about the safety of any children in the home, further impacting on the family.
Prevention Matters can work with people to meet their basic needs and linking them with other agencies who can provide things like food and basic household equipment. Part of the Prevention Matters service is to complete a strength-based assessment, which includes understanding the reason they are drinking, and showing them what support can be offered to enable them to see a brighter future.
Sadly, quite a few of the people keep coming back to Prevention Matters with differing ongoing issues. Accepting they have an alcohol problem is the first step to recovery, but unfortunately many do not acknowledge there is a problem and this has led to some of our clients passing away at home or in hospital.
When we support families after a death they can have mixed feelings. There can be a mixture of sorrow and relief as caring for a family member with alcohol issues can be a struggle, with people finding it hard to maintain jobs and relationships as well as their caring responsibilities."
Impact on children
Across England it is estimated that between 189,000 and 208,000 children live with an alcohol-dependent adult. 14,000 of these children live with two alcohol-dependent adults. In 2014/15, 26% of patients receiving treatment for alcohol problems in England lived in a house with a child. In Buckinghamshire, 25% of clients receiving treatment for alcohol problems live in a house with a child.
When a parent misuses alcohol, this can lead to disorganised and unpredictable parenting, disrupting the healthy development of the child.
Research shows that many children living with alcohol-dependent parents feel socially isolated. Many of these children feel sad or anxious but are less likely to seek help because they feel embarrassed or guilty and they do not want to betray their parents.
Children of alcohol-dependent parents may also need to care for their parents or siblings. This responsibility can mean children miss school more often or are unable to complete their homework. A reported 7% of young carers are looking after a parent, caregiver or relative with a drug or alcohol problem. Amongst these children, 40% missed school or had other issues at school.
The impact of parents drinking alcohol is not limited to families with someone who is alcohol-dependent. The amount and frequency of drinking that is needed to impair parenting is not clear. However, a report found that for children of parents who aren’t dependent on alcohol, 18% of children reported feeling embarrassed by seeing their parents drunk.
Another 15% of children said their bedtime routines were disrupted due to their parents’ drinking.
Physical and mental health impacts on children
A child’s mental and physical health is impacted when their parent misuses alcohol. These children are more likely to be obese, have an eating disorder, have attention deficit hyperactivity disorder, be injured and/or be admitted to hospital. Compared to other children, children of parents who are alcohol dependent are twice as likely to experience difficulties at school, three times more likely to consider suicide and four times more likely to become dependent drinkers themselves.
The risk of children suffering harmful consequences from parental alcohol misuse is reduced if children are from families with high levels of family support, where there is a non-drinking parent who can reduce the negative impact of the drinking parent and where there is security, for example a regular household income.
There is also evidence that resilience is important in helping children to cope with a parent drinking too much. There are a number of ways to help a child to develop resilience, for example through encouraging them to take part in activities outside the family home.
Until relatively recently, interventions for harmful drinking have tended to focus on the individual user. However, the vital role that family members can play in the treatment process is now well recognised as is the need for support for family members.
Neglect and abuse
There is a strong relationship between parent or carer alcohol use and child maltreatment. A study found that 61% of applications for care in England included the misuse of alcohol and/or drugs. Alcohol misuse was also reported for 37% of cases of death or serious injury of a child through neglect or abuse in England between 2011 and 2014.
A recent analysis in England found parental alcohol use was present in 37% of all serious case reviews of child abuse.
Impact on Buckinghamshire’s children
Social care referrals for children include a primary need for each child. In Buckinghamshire for 2017/18, 2% of all referrals included parental alcohol misuse as the primary need. A small number of referrals were due to the child misusing alcohol.
In Buckinghamshire, 22% of children who had a completed children in need assessment in 2017/18 had parental alcohol misuse as an identified need (2017/18). This is higher than England where 18% of completed assessments by children’s social care have parental alcohol misuse identified as a need.
This data suggests strongly that alcohol misuse is not often recognised as one of the primary issues as to why a parent may not parent their child appropriately. However, assessment uncovers alcohol to be a factor in over 20% of open cases.
An audit in 2015 of looked after children in Buckinghamshire found 17% (24 of 141) of the cases reviewed had alcohol misuse as an issue at the time they came into care.
Domestic abuse and violence
Alcohol consumption can be both a cause and consequence of domestic abuse and violence.
Alcohol misuse is associated with a fourfold risk of violence from a partner and is commonly present where sexual violence occurred. Binge or heavy drinking is most strongly associated with domestic violence.
Women experiencing domestic violence are up to 15 times more likely to misuse alcohol than women who are not victims of domestic violence. Many women use alcohol to help them cope with domestic abuse, and some women are given alcohol by their partner in order to increase control over the women.
When both partners have been drinking, the violence may be more severe and women may be less able to protect themselves.
The impact on children in a household where there is domestic abuse can be long lasting. Emotional well-being, behaviour (including anti-social behaviour and bullying), educational attainment, risk-taking (including alcohol and substance misuse), and long term life chances may all be affected.
In Buckinghamshire, Women’s Aid services work alongside the substance misuse services to refer people who need support for this part of their recovery.
Growing up with alcohol in Buckinghamshire - a resident’s view
The behaviour of families influences their children. One Buckinghamshire resident grew up in a family where alcohol was misused, and this impacted her own life into adulthood.
"Alcohol was a huge part of my life growing up but always in a negative way. My dad was alcohol dependent, so was my grandfather, my step mum and her sister. In my early 20s I realised my mum also had a drink problem. I found her passed out on the bathroom floor, and I’d find empty sherry bottles down the side of the sofa. She’d get aggressive; I remember having to shut myself in the bedroom as she tried to kick the door down. I’d grown up with all these role models, and then as a young adult I met my first proper boyfriend. We were always out socialising, and looking back now he was an alcoholic too.
There’s no single trigger point that started my drinking, I just always have drunk, and various things in my life have caused me to start or to stop.
I ran my own hairdressing business for ten years. When I found myself working 12 hours a day it was so stressful that I turned to drink to cope. I was a fully functioning alcoholic - I owned my own home and I ran my business. I drank in the evenings so it was hidden from others. In the end I sold my business and moved in with my mum to sort myself out. I stopped drinking for six months. I then got a job in hairdressing and started again.
When I met John*, my husband, I stopped again. He was a good role model because alcohol is not part of his routine. When I had my daughter Sarah*, who has a learning disability, I didn’t go to antenatal groups so I had no other young mums around and John was working away.
I became socially isolated and started drinking again. Sarah is now eight, and I continued drinking. I’ve always picked my time, mostly drinking after she had gone to bed.
Going to the gym has been a stress relief, but last year I broke my ankle (from a fall when drunk) and I was barely mobile for a year. I was in hospital having plaster put on my leg and I realised I was wasting my life. I didn’t want to be like my mother, and I didn’t want Sarah to experience what I have, so I called One Recovery Bucks.
My case worker has been brilliant. She encouraged me to come to group meetings. It’s so humbling to listen to other’s stories. I’ve realised I’m not the only one struggling and that’s helped take the pressure off. When I heard others recovering I thought ‘I can do that too’.
The first few weeks were the worst. I learned to distract myself until the craving pass, and to challenge the voice in my head encouraging me to drink. I’ve changed my routine so I don’t see alcohol at my trigger time of day, which is when Sarah comes home from school. Now instead of me drinking, we have snacks together and then she does her homework. It’s hard and I’m always worried that I’ll have a relapse like before, but Sarah is my motivation. Without her it would have been much harder to turn myself around."
*Names have been changed
Impact on violence and crime
Crime and disorder
Research shows short term high alcohol consumption is associated with aggression and violence and alcohol increases the risk of impulsive and violent crime.
In England, victims of violent crime believed that the perpetrators were under the influence of alcohol in 46.2% of all violent incidents in 2016/17.
In 2016/17 in England and Wales, in 12.4% of theft offences, 20.6% of criminal damage, 21.5% of hate crimes were alcohol-related and 35.8% of sexual assault cases the offender was under the influence of alcohol. In 2018/19 in Buckinghamshire, 1% of theft offences, 4% of criminal damage and 9% of sexual assaults (including rape) were deemed to be alcohol-related.
National research shows that violence is often associated with the sale of alcohol in pubs, bars and nightclubs, which are an important part of the night time economy. Although the night time economy generates business, there are often costs to individuals and the wider community, including crime and fear of crime, ambulance, hospital and A&E costs, street cleaning around late-night venues, takeaways and noise and light pollution.
Between 2014-2016 in England and Wales, alcohol-related violent incidents made up 67% of violent incidents that took place at the weekend and 68% of those that took place during the evening and night. In 2014-2016 in England and Wales, 91% of violent incidents that took place in or near a pub or club were alcohol-related, and 67% of those that took place in public spaces were alcohol-related. Levels of public violence and disorder are associated with the number of pubs and clubs concentrated in an area, and increased number of premises is associated with increased levels of violence and public disorder.
Surveys in other parts of England have found nearly half of respondents avoid town centres at night due to drunken behaviour of other people and alcohol-related litter in their town centres.
In 2004/05, the prevalence of alcohol use disorders was much higher amongst people in prison compared to the general population. Of over 700 survey respondents, 63% of men and 57% of women in prison were identified as having an alcohol use disorder*, with over a third of all individuals scoring within the possibly alcohol-dependent range.
Prevalence of alcohol use disorders in the general population for the same time period was 26%.
Youth offending
One effect of parental alcohol misuse is that their children are at an increased risk of involvement in crime. In Buckinghamshire, 12.9% of assessments completed by the Youth Offending Service found the young person was using alcohol. Almost half of those who used alcohol began drinking at the age of 13.
Drink driving in Buckinghamshire
Road traffic accidents
The legal limit for alcohol when driving in the UK is 35 micrograms of alcohol per 100ml of breath. However, any amount of alcohol affects your ability to drive safely. The effects can include slower reactions, increased stopping distance, poorer judgement of speed and distance and reduced field of vision, all increasing the risk of having an accident or fatality.
There have been significant declines in alcohol-related road traffic crashes on Britain’s roads. However, in 2014 there were over 5,600 alcohol-related crashes and over 8,000 casualties, of which 240 people were killed and over 1,000 people were seriously injured. Men account for 70% of those killed or seriously injured on the road, and 25% of those killed or seriously injured are aged between 25 and 39 years.
Police may conduct breath alcohol tests for some crashes. According to Public Health England, in Buckinghamshire between 2014 and 2016 there were 102 alcohol-related road traffic accidents. This means for every 1000 road traffic accidents, 33 were alcohol-related which is 25% higher than the England average.
Alcohol and crime - a police officer’s view in Buckinghamshire
A Thames Valley Police Constable in Aylesbury shared her thoughts on the impact of alcohol in domestic abuse incidents, violence and road traffic incidents:
"Alcohol is ever present in our work and if I could put a statistic on how often it is linked to the cases we are called out for, I am sure the number would be significantly high.
Alcohol is often involved in a variety of our town centre and domestic abuse incidents. Despite so much publicity about not drinking and driving, it is still a factor in many road traffic offences.
Alcohol is involved in a substantial number of the domestic abuse incidents we attend. It can be both partners who are drinking or just one, and it can be any time of the day or night. People may think that domestic abuse incidents, involving alcohol, are often among a couple in difficult economic circumstances, but this isn’t always the case. I have attended incidents involving a number of family dynamics. I have attended impoverished addresses and large affluent properties. Issues involving alcohol consumption are not exclusive to any one community or type of person. However, there are now an amazing array of agencies and groups that support those looking for help and to make changes. When I started in this job I had the misconception that most drink driving offences would be among older people who were not aware of the ‘don’t drink and drive’ campaign – I was wrong. There is no particular demographic. I have seen young people who have just passed their test, to professional people, to older people with a routine of doing this for a long time.
I think many people don’t know how many units of alcohol they are actually consuming.
They think they are alright to drive after drinking two pints, but they do not consider the strength of the alcohol they have consumed, or what food they have eaten. It is not understood that after drinking, your alcohol level increases and time is needed to elapse before it begins to go down. Also, younger people seem to be drinking more spirits and higher strength drinks, which I think could increase. I am trained to conduct evidential breath testing, and it is interesting to see that some people who appear to be fine, are actually well over the limit.
I think binge drinking has changed due to the rise in the price of alcohol in pubs and clubs. People now pre-drink at home, and just ‘top up’ when they go out. They come out later in the evening when they have consumed a lot of alcohol. This puts pressure on door staff who can turn them away for being drunk, before they have done anything they think is wrong. This can often be the cause of altercations. If a group is then split up, the drunk person is often left alone, which increases the risks to them, such as hypothermia, or being victim of a serious sexual or violent crime due to their vulnerability. The Street Angels do a great job helping people who are drunk, keeping them safe, warm, and getting home safely, but they can’t help everyone. You might think this is more typical of women, but we frequently see this among men."
Impact on work and economy
Alcohol has an impact on the economy and the workforce. Estimates show the costs of alcohol misuse to the economy and workplace are high with absenteeism, unemployment and early death having the biggest impacts. The UK economy loses £7.3 billion annually due to lost productivity from drinking alcohol, according to the Cabinet Office.
People who misuse alcohol are more likely to take sick leave due to having a hangover or an alcohol-related illness.
At the population level, an increase in alcohol consumption of one litre per person results in a 13% increase in sickness absence among men.
Unemployment and alcohol
The relationship between alcohol-related problems and unemployment is complex. Unemployment can lead to alcohol consumption, and alcohol consumption can lead to unemployment.
Becoming unemployed increases the chance of developing an alcohol use disorder by six fold compared to those who remain in employment.
Rates of alcohol and illicit drug misuse or dependence increases one to four times among young people after six months of unemployment compared to their employed peers. Unemployed adolescents and young adults have significantly higher rates of substance use compared to their employed counterparts.
Difficulties with employment are frequently experienced by those with alcohol dependence. People with an alcohol use disorder are at twice the risk of moving from employment to unemployment. Drinkers who consume alcohol at higher risk are six times more likely not to be employed than low risk drinkers. Studies show there are high unemployment levels for people with alcohol dependence (average 53% unemployed).
In England in 2014/15, 73% of people seeking treatment for alcohol problems were not in paid employment at the start of their treatment.
In Buckinghamshire (2017/18), 60% of people seeking treatment for alcohol dependence from One Recovery Bucks were not in paid employment.
Economic impact of alcohol
The total annual cost to England and Wales from alcohol-related harm is over £21 billion. The cost of alcohol to the NHS in England is £3.5 billion per year, and each year England spends £11 billion on alcohol-related crime.