Alcohol and Open Water:

a risky cocktail

Kirsty Wilkinson

Alcohol Harm Reduction Coordinator,

Public Health

A quick test

• How many units?

• 125ml glass

• 12% ABV

• Rose wine

1.5 UNITS

• How many units?

• 250ml glass

• 12% ABV

• Red wine

3 UNITS

• How many units?

• 1 pint

• 3.6% ABV

• Lager

2 UNITS

• How many units?

• 330 ml

• 5% ABV

• Bottle

lager/beer/cider

1.7 UNITS

• How many units?

• 25 ml

• 40% ABV

• Vodka/Gin/Rum/

Whisky/Tequila/

Sambuca

1 UNIT

The maths:

Strength (ABV) x Volume (ml) ÷ 1,000 = units

12% x 125ml ÷ 1,000 = 1.5 units

• What do you get on the AUDIT-C?

• Score of 5+ indicates increasing risk

drinking

Alcohol – The Stats

• Top 5 risk factor for disease, disability and death

(WHO, 2014)

• Harmful use of alcohol is the leading risk factor for

death in males aged 15–59 years

• Causal factor in over 200 disease and injury

conditions (WHO, 2014)

• Not only volume but pattern of drinking affects risk

• The more you drink and the more often you drink the

more your ‘risk’ of harm increases

• Fuels inequalities – people who live in deprived areas

have poorer outcomes

Alcohol and drowning • Alcohol has been a factor in 103 fatal

coastal incidents from 2010-2013

• In adults of working age alcohol is a

factor in about 1 in every 3 drownings

• Drowning is a leading risk factor in

males dying prematurely (age 15-59)

(WHO, 2014)

• Males – drink more frequently and in

larger volumes (WHO, 2012)

• Avoidable deaths (WHO, 2014)

Alcohol and drowning

• Impairs judgement – distorts perception

of risk

• Increases risk taking behaviour –

removes inhibition

• Reduces coordination – numbs senses,

unsteadiness – ability to swim is

reduced

• Impairs reaction time

Alcohol and drowning

• Physical changes

• Inner ear – balance – sudden changes of

temperature can cause disorientation

• Hypothermia – draws blood away from

limbs to vital organs – more difficult to

swim

Alcohol and drowning

• Pattern of drinking (i.e. binge or heavy

episodic drinking (HED)) linked to

intentional and unintentional injury

(MacDonald et al 2013)

Have patterns of drinking

changed? • Home –v- Pub/Club

• Drink to get drunk

• Bigger/uncontrolled measures – drink

as much as you want!

• Pre-loading – drink before going out

for the night

• Long drinks –v- shots

• Energy drinks into the toxic mix

Individual responsibility or societal

issue?

OTHER MODEL

Problem – few bad

people who can’t

control themselves

Solution –

partnership, self

regulation, education

PUBLIC HEALTH MODEL

Problem – addictive

drug irresponsibly

produced, priced,

promoted, sold

Solution - regulation

The Evidence: REDUCE AFFORDABILITY

• Alcohol 61% more affordable than

1980

• NICE: “Making alcohol less

affordable is the most effective way

of reducing alcohol related harm”

• MUP (50p): • Targets children and heavy drinker

• Doesn’t penalise moderate drinkers or poor –80%+

lives saved from less affluent

• Would help community pubs

• Deaths down 960; crimes down 50,700; hospital

admissions down 35,100

The Evidence: REDUCE AVAILABILITY

• Places selling alcohol doubled since 1950s

• NICE: “…making it less easy to buy alcohol …

is another effective way of reducing alcohol related harm”

LICENSING ACT

• Presumption to approve

• Move to off sales, pubs closing

• More inappropriate locations – soft play,

multiplex cinemas

The Evidence: REDUCE ADVERTISING

NICE: “…children and young people should be protected

as much as is possible by strengthening the current

[marketing] regulations”

LATEST

• 1 in 4 cinema ads for alcohol

• Children see more TV alcohol ads than adults

• Football on TV – 111 visual references to alcohol an

hour

• UK has some of laxest regulation in Europe

The Evidence:

SCREENING and BRIEF ADVICE

• NICE: “NHS professionals should routinely carry out

alcohol screening as an integral part of service

provision …non-NHS professionals should focus on

groups that may be at an increased risk of harm

SPECIALIST TREATMENT

• Treatment effective and cost effective – 1:5 ROI

• NICE, DH, Alcohol Concern all recommend c15%

dependent drinkers should be in treatment

Questions?