Friday, 16 January 2015
Drug and alcohol misuse causes a number of social ills. It damages the health and ruins the lives of individuals; it affects family life and contributes to crime rates. The costs to society (and individuals) are enormous. Tackling alcohol and drug misuse is a complex problem and requires integrated solutions and co-ordinated delivery of services involving education, health and social care, intelligence and enforcement and economic policy.
Whilst it is difficult to estimate the number of offences that are related to alcohol or illicit drug use, it is well established that there is a link between substance use and crime. The 2005 Offending Crime and Justice Survey included questions on offending among young people aged 10 to 25 years related to alcohol and illicit drug use. For 18% of all violent offences and 10% of all property offences, offenders were under the influence of alcohol. For 3% and 2% of all violent offences and all property offences, respectively, offenders were under the influence of illicit drugs (Wilson D. 2006).
Among the general population, alcohol dependence affects 9% of men and 3% of women in
24% of adults drink alcohol in a way that puts them at risk of physical and
psychological harm (McManus S. 2009).
Although general population surveys significantly underestimate the numbers of dependent drug users it is believed that around 3% of adults in
signs of dependence on illicit drugs (typically cannabis). For other illicit
drugs, 0.4% show signs of dependence on cocaine and 0.1% each show signs of
dependence on crack, ecstasy and heroin/methadone (Department of Health 2011).
Alcohol use has been linked to the development of a number of chronic conditions (increased risks of hypertension, stroke, coronary heart disease, liver cirrhosis and some cancers) and acute consequences (including violence and road traffic accidents). Using alcohol attributable fractions produced by Public Health England within the Local Alcohol profiles (LAPE 2014), it is estimated that in 2012 65% of all alcohol related deaths in England occurred in men. As well as sex alcohol-related deaths vary by age, with 39% and 46% of deaths occurring in the ages 35 – 54 and 55 – 74 respectively (ONS 2014).
The majority of recorded drug-related deaths are related to opioid use and mostly occur among injecting drug users (Bird S. M. 2010). The main cause of directly attributable drug related deaths was accidental poisoning whilst using heroin/morphine. However, deaths from AIDS among injecting drug users accounted for 8% of all AIDS deaths in
England and Wales in
2009 (Davies C. 2010).
Hospital admissions arising from diseases or conditions directly and indirectly related to substance use make up a large contribution of the costs to the NHS. Studies of the health-related costs of substance use indicate an annual spend of nearly £3bn on alcohol misuse in
just under £500m on Class A drug use in England and Wales (Department
of Health 2011). In addition, older people who continue to use drugs and
require the support of health services are emerging as an important but
relatively under-researched population (Department of Health 2011).
In 2008, the Home Office calculated that the costs associated with alcohol-related crime were between £8.75bn and £14.78bn. These costs were mainly incurred as a result of less serious wounding, criminal damage, sexual offences and causing death by dangerous driving. The costs associated with drug-related crime were last updated in 2003-04 and estimated at £13.32bn. The estimation of these costs included the following offence categories: fraud, burglary, robbery and shoplifting (Department of Health 2011). It has also been estimated that there is a £7bn loss of productivity due to alcohol, and that, for every £1 spent on drug & alcohol interventions for young people, there are between £5-£8 worth of benefit (Public Health England 2013).
Bird S. M., Hutchinson S. J., Hay G., King R. Missing targets on drugs-related deaths, and a Scottish paradox ; 21: 155-9. International Journal of Drug Policy, 2010.
Davies C., English L., Lodwick A., McVeigh J., Bellis M. A. United Kingdom drug situation: annual report to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) 2010. Liverpool: UK Focal Point on Drugs. 2010.
Department of Health. A Summary of the Health Harms of Drugs. Available from http://www.nta.nhs.uk/uploads/healthharmsfinal-v1.pdf, 2011.
LAPE. Local Alcohol Profiles for England. Public Health England, 2014.
McManus S., Meltzer H., Brugha T., Bebbington P., Jenkins R. Adult psychiatric morbidity in England, 2007. . The Health & Social Care Information Centre, 2009.
ONS. “Alcohol-related deaths in the United Kingdom, registered in 2012.” 2014.
Public Health England. Alcohol and drugs prevention, treatment and recovery: why invest? 2013.
Wilson D., Sharp C., Patterson A. Young People and Crime: Findings from the 2005 Offending, Crime and Justice Survey. London: Home Office, 2006.