September2 2020 - Page 8

ALCOHOL Blocking the path How well is England doing at getting people who need help into treatment for their drinking problems? It matters, because the more of the in-need population we treat, the smaller the alcoholdependent population and the less the related harm. Drug and Alcohol Findings conducted an examination for England in 2014 when the figures were most reliable (see dl.php? for the full story and references). Then, about 112,000 drinkers were in specialist treatment. We found rationales for this representing just 7.5 per cent of harmful or at least mildly dependent drinkers, and up to 43 per cent of those who score in surveys as at least ‘moderately’ dependent. In between was a 19 per cent estimate based on a formula constructed for the Department of Health. This aimed to exclude drinkers who, despite a high risk to What proportion of England’s problem drinkers are actually in treatment? And are increasing rates of unmet need the result of austeritydriven funding cuts? Mike Ashton investigates health, scored as non-dependent in surveys, but to include lower-risk drinkers dependent enough not to remit, even after an extended brief intervention. The population in need of treatment becomes constricted further if we take into account whether prospective patients actually want or intend to take a treatment route to curbing their drinking, and/or are making what to them seems a rational choice to continue to drink to excess. COULD DO BETTER Though the question of what proportion of the in-need population is in treatment has several answers, what seems sure is that England could be doing better – not least because Scotland seems to be treating proportionately three times as many of its problem drinkers. An estimate for Leeds is that raising treatment access to that level would cut the alcoholdependent population by nearly a fifth over five years, and save a further 65 lives. Since 2014, however, things seem to have got worse (Fig 1). Initiated in 2010, the government’s austerity policies are prime targets for the underlying reason why alcohol treatment numbers have been falling despite sustained levels of need – the chart shows numbers falling consistently since 2013-14. The highest line is the number of patients whose presenting substance use problems included alcohol, the lowest those with alcohol as their sole presenting substance use problem. In between are actual or estimated numbers of patients treated primarily for their drinking problems, the basis for the calculations above. These figures must be married with trends in estimated treatment need to assess whether need is increasingly failing to be met. The methodology which yielded the 19 per cent estimate for 2014 has been used to estimate the alcohol-dependent population in England from 2010-11 to 2017-18. In 2017-18 the estimate was just 1.6 per cent lower than in 2013-14, yet over the same period the patient caseload fell by about 17 per cent – from equivalent to just over 19 per cent of the in-need population to 16 per cent (see chart). The drop was within margins of uncertainty, but was consistent each year from 2013- 14. With a presumed substantial pool of unmet need, even if there had been no fall in the proportion of the in-need population being treated, a diminishing caseload would still have been of concern. HOSPITAL ADMISSIONS Another statistic used to indicate need for treatment is hospital ‘Austerity might increase unmet need by obstructing the main routes for converting need into demand for and entry into treatment.’ 8 • DRINK AND DRUGS NEWS • SEPTEMBER 2020 WWW.DRINKANDDRUGSNEWS.COM