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ALCOHOL PILOT PROJECT 2015 CAAP©

MEASURING PROBLEM ALCOHOL USE USING

ROUTINE RESEARCH DATASUZI LYONS

HEALTH RESEARCH BOARD

Measuring problem alcohol use using routine surveillance data

Dr Suzi Lyons, 20th January 2016

Overview

• Drug treatment data from the National Drug Treatment Reporting System

• Alcohol Diary – interactive tables and on-line data

• Drug-related deaths from the National Drug-Related Deaths Index

Drug treatment data

National Drug Treatment Reporting System (NDTRS)

• Health information system/epidemiological database• 1990 started in Dublin; 1995 expanded nationally• 2004 alcohol included as a main problem drug• Co-ordinated by the Health Research Board• Purpose - to provide information on trends in treated

problem drug and alcohol use• 75% coverage although participation is not uniform

NDTRS - methodological points

• All new treatment episodes in a calendar year• As per EU reporting criteria• Annual data does not include those who are in continuous

treatment• Case based, not individual based - no unique health

identifier in Ireland

National trends treated problem alcohol and drug use, main problem, NDTRS 2008 to 2013

2008 2009 2010 2011 2012 20130.0

10.0

20.0

30.0

40.0

50.0

60.0

AlcoholOpiatesCannabisBenzodiazepinesCocaineOthersAmphetaminesEcstasyVolatile inhalants

Prop

ortio

n of

case

s

Data for 2012 & 2013 is unpublished but subset available on-line

Incidence and prevalence of treated problem alcohol use, NDTRS 2009 to 2013

Proportion of cases treated for problem alcohol use by type of treatment service, NDTRS 2009 to 2013

2009 2010 2011 2012 2013

Outpatient 56.9 53.1 53.9 54.1 55.9

Residential 40.7 41.0 39.3 39.7 37.2

Low-threshold 2.4 5.8 6.9 6.2 6.9

36% 64%

Median age in treatment 40 (19 to 64)

Median age first used alcohol

15 (12 to 22)

Characteristics of cases treated for problem alcohol use, NDTRS 2013

Employed Homeless Early school leavers

0

5

10

15

20

25

21.5

5.7

13.5

Prop

ortio

n

56.919.0

13.1

11.0

Problematic use

Dependant drinkerHarmful drinkerNot knownHazardous drinker

Treatment status by problematic use, NDTRS, 2013

Hazardous

drinkerHarmful drinker

Dependant drinker

Not known

Never treated 66.3% 61.5% 42.3% 34.0%Previously treated 31.8% 36.5% 56.9% 56.9%Not known 1.8% 2.0% 0.8% 9.2%

Treatment status by problematic use, NDTRS, 2013

Hazardous

drinkerHarmful drinker

Dependant drinker

Not known

Never treated 66.3% 61.5% 42.3% 34.0%Previously treated 31.8% 36.5% 56.9% 56.9%Not known 1.8% 2.0% 0.8% 9.2%

Source of referral by problematic use, NDTRS, 2013

Hazardous drinker Harmful drinker Dependant drinker0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

36.2%35.2%

37.7%

11.1%

8.1%9.8%

2.0% 2.2%

6.1%

8.3%

13.7%15.0%

10.8%

23.0%

17.7%18.6%

10.4% 9.7%10.4%

5.6%

2.6%1.2% 1.2%

0.7%

SelfFamily and friendsOther drug treatment centreGeneral practitionerHospital or other medical sourceSocial servicesCourt/probation/policeOther

Source of referral by problematic use, NDTRS, 2013

Hazardous drinker Harmful drinker Dependant drinker0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

36.2%35.2%

37.7%

11.1%

8.1%9.8%

2.0% 2.2%

6.1%

8.3%

13.7%15.0%

10.8%

23.0%

17.7%18.6%

10.4% 9.7%10.4%

5.6%

2.6%1.2% 1.2%

0.7%

SelfFamily and friendsOther drug treatment centreGeneral practitionerHospital or other medical sourceSocial servicesCourt/probation/policeOther

Source of referral by problematic use, NDTRS, 2013

Hazardous drinker Harmful drinker Dependant drinker0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

36.2%35.2%

37.7%

11.1%

8.1%9.8%

2.0% 2.2%

6.1%

8.3%

13.7%15.0%

10.8%

23.0%

17.7%18.6%

10.4% 9.7%10.4%

5.6%

2.6%1.2%1.2%

0.7%

SelfFamily and friendsOther drug treatment centreGeneral practitionerHospital or other medical sourceSocial servicesCourt/probation/policeOther

Problem alcohol use: poly drug use, NDTRS, 2013

41%

18%

16%

9%

8%4%4%

CannabisCocaineBenzodiazepinesOpiatesEcstasyOther drugsAmphetaminesVolatile inhalants

National Alcohol Diary Survey

Alcohol Diary

The main objective of the National Alcohol Diary Survey was to:• Estimate personal consumption of, and expenditure on, alcohol

among the general population aged 18–75 years living in private households in Ireland

• National survey with 5,991 randomly selected participants conducted between July and October 2013

• Weighted by age, gender and regional distribution• Household response rate of 67.2%

Key Irish data at http://www.drugsandalcohol.ie/key-info/

Heading to go here

Graph• Bullet points to go here bullet points to go here bullet points to go here bullet points to go here

Drug-related deaths

The National Drug-Related Deaths Index (NDRDI)

• Families, through the NFSN, advocated for accurate figures– Underestimation of number of drug-related deaths

• Action from the National Drug Strategy 02-08• Aim:

– Census of drug and alcohol-related deaths and deaths among drug users and those who are alcohol dependent in Ireland

– To allow the State to respond in a timely manner with accurate data on drug-related mortality

The National Drug-Related Deaths Index (NDRDI)

• Four sources: – Coroners: 48 districts with ~16,000 deaths reported annually– Hospital In-patient Enquiry Scheme (HIPE) : 61 hospitals– Central Treatment List (CTL) - Register of methadone treatment for opiate

dependence– General mortality register (GMR)

• Inclusion criteria: – Documented history of illicit drug use– Documented history of misuse of licit medication– Documented history of alcohol dependence– Where drugs or alcohol were implicated in the death by the coroner

Overview of all drug-related deaths, NDRDI, 2013

Poisoning deaths

All poisoning deaths, NDRDI, 2004 to 2013 (n=3,519)

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

50

100

150

200

250

300

350

400

450

Num

ber

• 68% Male

• Median age of 41 years

Type of drugs implicated in poisoning deaths 2004 - 2013

Specific drugs implicated in poisoning deaths, NDRDI 2004 to 2013 (Multi-response)

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

20

40

60

80

100

120

140

160

180

200

AlcoholDiazepamMethadoneHeroinZopicloneFlurazepamCocaineOlanzapineCitalopramMDMA

Num

ber

34

Alcohol-related poisoning deaths, NDRDI 2004 to 2013

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

5

10

15

20

25

30

35

40

45

50

All poisonings where alcohol was involved

Alcohol only poisoningsProp

ortio

n

Types of drugs implicated along with alcohol, NDRDI, 2013

Benzodiazepines Opiates Antidepressants Other prescription meds0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

83.3

48.746.2

37.2

Summary

• Alcohol is the drug most commonly treated in Ireland– Many of those who present for the first time are already alcohol

dependent, making it harder to have successful outcomes

• Alcohol is a major contributor to poisoning deaths– Implicated in 35% of all deaths in 2013– 15% of all poisonings were due to alcohol alone in 2013

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ALCOHOL PILOT PROJECT 2015 CAAP©

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