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Ymunwch â’r Sgwrs! Join the Conversation!

Alcohol Awareness Toolkit

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Health Risks Associated with Heavy

Drinking

Liver Disease

cirrhosis of the liver

Alcohol Related Anaemia

and Nutritional

Disease

Chronic Calcifying

Pancreatitis

Heart Muscle Damage

cardiomyopathy

Alcoholic Dementia

Psychiatric Disorders

Welcome to the Alcohol Awareness Toolkit

This toolkit has been developed by Public Health Wales in partnership with Alcohol Concern

using many of the resources and images provided by Change 4 Life. The toolkit is intended for

use by any person or organisation who would like to raise awareness of alcohol use and misuse

with colleagues, communities, families and friends. It will provide all the necessary tools and

resources to plan, run and evaluate an alcohol awareness campaign.

Alcohol is a major preventable cause of death and illness. Around 1,500 deaths in Wales are

attributable to alcohol each year (4.9% of all deaths).1 Problem use of alcohol can cause serious

social, psychological and health problems, affecting work, social and personal relationships.

Health risks associated with heavy drinking include:

1. Public Health Wales Observatory 2014. Alcohol and Health in Wales 2014. Wales Profile.

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Alcohol in Wales and Hywel Dda

Alcohol has recently been identified as the third highest risk to health in developed countries

(Alcohol Concern, 2006). The most recent data from the Welsh Government (2015)2 on

referrals to substance misuse treatment services show an increasing trend in substance misuse

with alcohol related referrals being the main problematic substance. An overview of these

findings are provided below:

There were 26,385 referrals for treatment of alcohol or drug misuse notified to the

database in 2014-15. This represents a substantial rise in referrals, following two years of

falling numbers (2011-12= 25,518; 2012-13= 24,691; 2013 – 14 = 24,001).

Based on 20,671 referrals (due to referral exclusions), 54 per cent of referrals were

related to alcohol as the main problematic substance.

Males accounted for 62 per cent of referrals for alcohol and the median age for alcohol

referrals was 42 years.

According to the Welsh Health Survey (2014) 39 per

cent of adults in Hywel Dda report drinking above

guidelines on at least one day per week and 23 per

cent of adults report binge drinking on at least one day

in the past week. Table 1 below provides an

overview of the Welsh Health Survey Data by county.

Adults who reported drinking above guidelines on at least one day in the past week Source: Welsh Health Survey (2014)

Adults who reported binge drinking on at least one day in the past week

Per Cent Observed

Age-Standardised Observed

Age-Standardised

Person

42 35 39 39 41

Person Person

26 18 24 22 25

Person

Ceredigion 41 24

Pembrokeshire 36 20

Carmarthenshire 39 24

Hywel Dda 39 23

Wales 41 25

Drinking in children and young people remains a concern with 17% of males and 14% of

females aged 11 – 16 in Wales drinking alcohol at least once a week. This is higher than in

Scotland, Ireland and England.3

2. Welsh Government (2015) Treatment Data – Substance Misuse in Wales 2014 – 2015 3. Public Health Wales Observatory 2014. Alcohol and Health in Wales 2014. Wales Profile.

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Why do people drink?

There are a number of reasons why people drink alcohol and these reasons may vary

considerably from person to person. By beginning to think about these different reasons, you

will begin to gain some useful insight into the nature of alcohol use in our culture. It may also

give you ideas for conversations you could have to encourage people to start thinking about

their relationship with alcohol. Listed below are the most common reasons that people give

for drinking on a regular basis:

Reward People often enjoy a drink to ‘wind down’ and it is seen as a reward after a stressful day at work

To Relax

Some consider having a drink as ‘me time’ once the children are in bed, or as one consumer described it, ‘part of my relaxation package’.

Routine

A number of people acknowledge that their patterns of routine drinking become difficult to disrupt. This leads to a belief that they might be too set in their ways to be able to break the pattern.

Alcohol Enhances The Social Experience

In this context, alcohol is frequently described as an ‘essential ingredient’, helping consumers to ‘fit in’ or be more confident in social situations.

Coping Mechanisms People often use alcohol as a way to manage stress, anxiety and/or depression.

Additional Reasons

Boredom

Feeling down

Pressure from others for example: ‘oh go on I am

having one’

Cheaper having a drink at home and more convenient

What about older adults?

As people get older, their bodies change so when alcohol is consumed it

is broken down more slowly, and they become more sensitive to the

effects of alcohol.

There are many factors and life changes associated with alcohol use by older adults.

Factors associated with higher rates of alcohol use

Emotional and social

Bereavement

Loss of friends and social status

Health

Physical disabilities

Chronic Pain

Insomnia

Sensory deficits

Other

Family history

Personality

Long term prescribing

Available finances

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Factors associated with higher rates of alcohol use

Emotional and social

Loss of occupation

Impaired ability to function

Family conflict

Reduced self esteem

Caring for an elderly partner or family member

Loss of independence

Needing

Stress

Depression

Social Isolation and loneliness

Retirement Adapted from Dar 2006

Health

Reduced mobility

Cognitive impairment

Disrupted sleep

Dar, K. (2006). Alcohol use disorders in elderly people: fact or fiction? Advances in psychiatric treatment 12(3):173-181.

Alcohol and Medication

The combination of alcohol with medications can also cause problems. Older people receive more prescriptions than any other age group and

are often dispensed multiple medications. Many medicines, both

prescription and over the counter, interact with alcohol.

These interactions may increase the effect of a medicine (e.g. the sedative effect of a hypnotic),

exacerbate a side effect (e.g. the drowsiness associated with anti-histamine use), or result in a

new syndrome (e.g. the unpleasant effects of combining alcohol and some antibiotics).

DID YOU KNOW?

Over 45s are three times more likely to drink alcohol every day.

People who work are more likely to drink alcohol than unemployed

people.

Around 200,000 people come to work with a hangover every day.

Alcohol is the second biggest risk factor for cancer after smoking.

Alcohol Concern UK

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Benefits to cutting back on alcohol

There are loads of benefits to cutting back on the alcohol. The most important one is the

reduced risk to your health, but there are lots of others too – you might be surprised!

Heavy drinking can be linked to depression, and sometimes a hangover can leave you feeling low. If you already feel anxious or sad when you are sober, drinking can make this worse. So cutting down may put you in a better mood generally.

Alcohol can disrupt your sleep patterns and stop you from sleeping deeply. So cutting down on alcohol should help you feel more rested when you wake up.

Once you start cutting back, you will probably notice the benefits quite quickly: Feeling better in the mornings, having more energy and feeling less tired during the day, and your skin may start to look better.

Cutting down on alcohol can reduce the chances of suffering from more serious health harms such as: alcohol-related cancers, heart disease, high blood pressure, stroke, liver disease, pancreatitis and reduced fertility.

Better Mood Feel In

Better Shape

Health Sleep Soundly

Benefits to cutting back on alcohol

Too much alcohol can really pile on the pounds. If you drink 10 pints a week, you could be taking on more than 120,000 calories a year. And there are more calories in a single measure of spirits than in the same volume of single cream. So if you cut back you will start to feel in better shape.

Source: NHS Choices, UK

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Why your setting should get involved…

Workplace: Alcohol can play a significant role in and around the workplace. It is often perceived as a stress-

reliever and an antidote to the daily pressures of demanding roles, as well as a way to socialise

and to network with colleagues and clients. However, drinking can lead to decreased

organisational productivity and long-term health problems.

Up to 17 million working days are lost each year because of alcohol-related sickness and the

cost to employers of sick days due to drink is estimated at £1.7bn.4 The total annual cost to the

economy is estimated to be £7.3bn (2009/10 prices).5

The workplace provides an ideal setting to target interventions around raising awareness of

alcohol related harm and on reducing alcohol consumption – it provides access to an

established population of adults, and provides a great opportunity to improve the health and

wellbeing of staff.

4. National Institute for Health and Clinical Excellence (June 2010), 'Business case: Alcohol-use disorders: preventing harmful drinking', p. 13 5. Home Office (November 2012), 'Impact Assessment on a minimum unit price for alcohol', p. 5

The impact of alcohol on the workplace:

Raised blood alcohol levels while at work affect both efficiency and safety -

meaning increased likelihood of mistakes, errors of judgement and

accidents.

Hangovers affect attendance and performance.

Persistent heavy drinking may lead to serious social, psychological and

medical problems which are associated with work attendance and

performance – for example, increased sickness absence.

Source: Alcohol in the workplace: Institute of Alcohol Studies

Factsheet, 2014

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Communities:

Communities provide an ideal setting to target interventions around raising awareness of

alcohol related harm and on reducing alcohol consumption. It provides access to community

groups and organisations as well as families and individuals within specific neighbourhoods.

The impact of alcohol on communities:

Health – liver disease, certain cancers and dementias, depression and

anxiety, birth defects.

Crime – disorder, violence, domestic abuse, vandalism and anti social

behavior.

Consequences – loss of driving licence, higher car insurance premiums,

loss of employment.

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How to get involved…

There are many ways for you or your organisation to get involved with the campaign and

promote key messages to your work colleagues, family and wider community. The following

section of the toolkit will outline some ideas which will be very easy to introduce and some that

may require a little more effort.

All the tools and information needed to put your campaign together are provided in the themes

section of this toolkit. This includes an evaluation form which we would be grateful if you could

complete and return after your campaign to help us understand how effective the campaign has

been across all organisations involved.

The following resources are also available for download at (control + click to follow link) www.drinkwisewales.org.uk/downloads/

2015 Alcohol Awareness Week toolkit (English)

2015 Alcohol Awareness Week toolkit (Welsh)

Dry January supporters’ booklet (English)

Dry January supporters’ booklet (Welsh)

Dry January poster (English and Welsh)

Dry January sponsorship form (bilingual)

Public Health Wales Dry January workplace challenge handbook (English)

Public Health Wales Dry January workplace challenge wall chart (English)

Change 4 Life alcohol advice booklet (English)

Change 4 Life alcohol advice booklet (Welsh)

Change 4 Life alcohol poster (bilingual)

‘What’s in your drink?’ unit information poster (bilingual)

Hair of the Dog alcohol conversation starter cards (English only)

Hair of the Dog poster (English only)

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KEY MESSAGES FOR

ALCOHOL AWARENESS CAMPAIGNS

39% of the adult population in Hywel Dda admit to drinking above

recommended guidelines on at least one day in the past week (Welsh

Health Survey, 2014).

Drinking over recommended guidelines daily or on most days of

the week increases the chance of developing liver disease, certain cancers,

dementias and developing alcohol dependency.

Sticking within the recommended daily guidelines (men: 3-4

units; women: 2-3 units) and having at least 2 alcohol-free drinking

days a week means there is only a low risk of harm.

If alcohol has crept up on you, get sneaky and cut back. Try to find

activities to wind down and relax that don’t involve drinking on at least 2

days a week and on days that you do drink, try to do so sensibly by using

the tips for swapping and nights out at Change4Life Wales | Alcohol

Also find local information and advice on Hywel Dda University

Health Board Hywel’s House website at Hywel Dda University Health Board

| Hywel's House

If you want to take up the challenge to give up drinking for a month,

consider having a ‘Dry January’ www.dryjanuary.org.uk

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CAMPAIGN

THEMES

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1. CONVERSATIONS ABOUT ALCOHOL…

Starting a conversation about alcohol consumption and the effects it may have on health, home,

family and working life may be challenging. Use the resources below to assess how much

people are really drinking, to ask open questions about drinking behaviour or to find out if there

is a specific issue that may be of concern. Use the signposting information at the end of this

toolkit to ensure those that are motivated to change, or those with harmful levels of drinking, are

referred to the appropriate services.

Resource to support a conversation about alcohol consumption:

To help people understand how harmful their drinking is you may want to ask them to complete

a short questionnaire called AUDIT C.6

AUDIT C is a short form version of the Alcohol Use Disorders Identification Test (AUDIT) (WHO,

2001) which was developed to screen for excessive drinking and in particular to help

practitioners identify people who would benefit from reducing or ceasing drinking. The majority

of excessive drinkers are undiagnosed and often present with symptoms or problems that would

not normally be linked to their drinking. As a first step in starting a conversation about alcohol

consumption use AUDIT-C, below, to quickly assess how risky individual drinking patterns are.

Each question (see below) has a set of responses to choose from, and each response has a

score ranging from 0 to 4. The score for each question should be entered onto the form (right-

hand column) and summed to give a total score. The total score will allow classification of

people into three groups: low risk, increasing risk or hazardous drinking and

harmful/alcohol dependent.

For clients with AUDIT-C scores 6 – 8 and no prior alcohol treatment, it may be useful to start a

conversation about alcohol consumption using the resources included in this section. Those

whose score indicates that they are at high risk (score of 7-8) should receive more intensive

treatment which may commence with feedback of their results and brief intervention. A total

score of 9 or more is a possible indicator of hazardous and harmful alcohol use, as well as

possible alcohol dependence requiring a full diagnostic assessment and/or referral to a

specialist drug and alcohol treatment service (see appendix for referral information).

6. AUDIT – C is the short form version of the Alcohol Use Disorders Identification Test (AUDIT, WHO 2001)

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Once people have had an opportunity to think about and assess their drinking use the

CONVERSATIONS ABOUT ALCOHOL Framework (page 15) to:

a) ask about drinking patterns;

b) offer some suggestions/advice;

c) signpost to support services.

AUDIT – C

Questions Scoring system

Your

score 0 1 2 3 4

How often do you have a drink containing

alcohol? Never

Monthly or less

2 - 4 times per

month

2 - 3 times per

week

4+ times per

week

How many units of alcohol do you drink on a

typical day when you are drinking? 1 -2 3 - 4 5 - 6 7 - 9 10+

How often have you had 6 or more units if

female, or 8 or more if male, on a single

occasion in the last year?

Never Less than

monthly Monthly Weekly

Daily or

almost daily

Scoring: A total of 5+ indicates increasing or higher risk drinking An overall total score of 5 or above is AUDIT-C positive

SCORE A

If you want to assess individuals for specific symptoms due to

drinking, the full AUDIT can be used as a brief assessment for

symptoms of alcohol abuse and dependence (See following page).

Pending New Guidance on AUDIT C:

In the coming months new guidance will emerge for using AUDIT C with older adults and scores will be grouped differently as per the ranges below:

0 – (non drinker)

1 – 3 (low risk)

4 – 6 (hazardous drinking)

7 – 9 (harmful drinking)

10 – 12 (potentially addicted)

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Remaining AUDIT questions: SCORE ‘A’ CARRIED OVER FROM ABOVE:

Questions Scoring system

Your

score 0 1 2 3 4

How often during the last year have you found

that you were not able to stop drinking once you

had started?

Never

Less

than monthly

Monthly Weekly

Daily or

almost daily

How often during the last year have you failed to

do what was normally expected from you

because of your drinking?

Never

Less

than monthly

Monthly Weekly

Daily or

almost daily

How often during the last year have you needed

an alcoholic drink in the morning to get yourself

going after a heavy drinking session?

Never Less than

monthly

Monthly Weekly

Daily or

almost daily

How often during the last year have you had a

feeling of guilt or remorse after drinking? Never

Less than

monthly

Monthly Weekly

Daily or

almost daily

How often during the last year have you been

unable to remember what happened the night

before because you had been drinking?

Never Less than

monthly

Monthly Weekly

Daily or

almost daily

Have you or somebody else been injured as a

result of your drinking? No

Yes, but not in the

last year

Yes, during

the

last year

Has a relative or friend, doctor or other health

worker been concerned about your drinking or

suggested that you cut down?

No

Yes, but not in the last year

Yes, during

the last year

TOTAL SCORE (A+B) = Scoring:

0 – 7 Lower risk

8 – 15 Increasing risk

16 – 19 Higher risk

20+ Possible dependence

SCORE B

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Conversations about alcohol7 Hints and Tips

Did you know...?

The NHS recommends that men drink no more than 3-4 units a day and women no more that 2-3 units a day.

It is recommended that men and women have a least two alcohol-free days per week.

A unit of alcohol is less than you think: a half pint of beer or a small glass of wine or a single shot of spirits.

You can binge drink more easily than your think. Binge drinking is when you consume double the daily recommended limit in one session.

Alcohol contains hidden calories. A pint of larger contains the same calories (170cal) as a sausage roll and a glass of red wine (175ml) contains the same calories (120cal) as a slice of cake.

ASK

What are your thoughts about your drinking? (you can use the

AUDIT C score to start the conversation). Are you interested in making a change to the amount of alcohol you drink?

ADVISE

What are the consequences of continuing to drink at your current level? Is there anything that concerns you about your drinking? What benefits do you think you would experience if you reduced your drinking?

ACT

Some people find it helpful to keep a diary of their drinking for a few days, to keep track of what and how much they drink. Would this be helpful for you? Have you considered talking to anyone about reducing your drinking? It can help to talk to family, friends or a health professional. Or contact the Wales Drug and Alcohol helpline 0808 808 2234 For more information on alcohol and support services available go to Hywel’s House Online Healthy Lifestyle Resource Centre: www.hywelddahb.wales.nhs.uk/healthy-wednesday

7. Source: Hywel’s Handbook to Health

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2. MYTH BUSTING

To raise awareness of the myths around alcohol distribute and discuss the MYTH BUSTER

factsheet below or use to create a display.

Myth True or False?

Facts

I can save up my drinks for the

weekend

FALSE

The recommended daily alcohol limits are 2 - 3 units for a woman and 3 - 4 units for a man. These amounts are intended to be spread out through the week, with at least two alcohol-free days in every seven.

Saving up your units from the week and drinking them all at once could leave you with a nasty hangover in the morning and some embarrassing memories of the night before, as well as increasing your risk of injuries, fights and accidents.

I can drink lots of alcohol and

still be in control

FALSE

Alcohol affects the brain like an anaesthetic, impairing judgement and coordination, and slowing reaction times, and so increasing your risk of accidents and injuries.

Alcohol improves sexual

performance

FALSE

Temporary impotence (or ‘brewer’s droop’) after a bout of drinking is a common problem experienced by men.

Men who drink heavily over a longer period may experience a loss of libido and potency, shrinking of the testes and a reduction in penis size.

Long-term heavy alcohol use in women may result in fertility problems, and the shrinking of breast and sexual organs.

Alcohol gives me a boost

FALSE

Alcohol is a depressant not a stimulant. It slows down how you think, move and react, and is unlikely to give you an energy lift.

Mixing alcohol with sugary energy drinks may give you a temporary boost, but this is likely to be followed by greater fatigue and sugar cravings.

Alcohol helps me sleep

TRUE/FALSE

Alcohol may make you feel sleepy and reduce the time it takes to fall asleep, but the quality of sleep is often poor.

Studies show that alcohol consumed as much as six hours before bedtime will increase wakefulness during the second half of your sleep, and keep you from getting the deep sleep you need.

Coffee sobers me up

FALSE

Drinking coffee may make you feel more awake, but it will not make you less drunk or cure a hangover. Plus, coffee is diuretic- it makes you pass water- and so may even worsen post-drinking dehydration.

Drinking caffeine may also make it harder for you to realise whether you are still drunk, leading to poor decision-making, such as driving whilst there is still alcohol in your blood.

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3. HOW MUCH ARE YOU DRINKING? Conversation Starter Activities: 1. Ask the person if they have seen an alcohol unit

wheel (page 35) before and tell them it is great for

working out the number of units in drinks. Ask the

person what their favourite tipple is and use the

alcohol unit wheel to tell them how many units and

calories are in 1 and 2 servings. Tell them the

recommended daily guidelines and relate to the number of units in their favourite tipple.

2. Ask them to pour their usual amount of wine or spirit into a wine glass or tumbler glass. Use

an alcohol unit beaker (page 35) to measure the number of units contained in their poured

serving. Tell them the number of units they poured and relate to the recommended daily

guidelines. (Props required: wine glass, tumbler glass, unit beaker, mock wine in an old wine glass or jug, mock

spirit in an old spirit bottle or jug).

3. Ask them to pour what they think is 1 unit of wine or spirit into a wine glass or tumbler glass.

Use an alcohol unit beaker to measure the number of units contained in the serving. Tell them

the number of units they poured and relate to the recommended daily guidelines. (Props required:

wine glass, tumbler glass, unit beaker, mock wine in an old wine glass or jug, mock spirit in an old spirit bottle or jug).

4. Ask people to guess the number of units contained in a range of alcoholic beverages e.g. a

bottle of whisky, a shot of tequila, a yard of ale. People could note down their name and the

number of units they think are on the table, you could allocate a prize to the winner.

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What are the recommended guidelines...?

Use the following resources to understand units and to help keep track of drinking (control

+ click to follow link):

All individuals are advised to take at least TWO ALCOHOL FREE DAYS A WEEK

Did you know?

One unit of alcohol is 10 milliliters (1 centilitre) by volume, or 8g by weight, of pure

alcohol.

A Wales survey in 2010 by Alcohol Concern Cymru found that over half (52%) of

drinkers did not know the recommended alcohol guidelines. In addition, the Welsh

Health Survey published in 2014 found that 41% of adults in Wales reported drinking

more than the recommended daily guidelines on at least one day in the past week.

Units don’t work like reward points. You can’t store them up for a big night out.

Drinking large amounts in one go cause’s additional physical damage.

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Using units is a simpler way of representing a drink’s alcohol content, which is usually expressed by the standard measure ABV, which stands for alcohol by volume and is a measure of the amount of pure alcohol as a percentage of the total volume of liquid in a drink. You can find the ABV on the labels of cans and bottles, sometimes written as “vol” or “alcohol volume” or you can ask bar staff about particular drinks. For example, wine that says “12% ABV” or “alcohol volume 12%” means that 12% of the volume of that drink is pure alcohol. You can work out how many units there are in any drink by multiplying the total volume of a drink (in ml) by its ABV (which is measures as a percentage) and dividing the result by 1,000.

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

units. For example, to work out the number of units in a pint (568ml) of strong lager (ABV 5.2%):

5.2 (%) x 568 (ml) ÷ 1,000 = 2.95 units

To make things easier NHS Choices

have developed a drinks tracker for the iPhone and an alcohol unit’s calculator to help you keep track and provide personalised feedback. For more information go to: http://www.nhs.uk/Livewell/alcohol/Pages/Alcoholtracker.aspx

See the guide (left) to find out how

many units are in your favourite drink.

‘Regularly’ means drinking this amount every day or most days

of the week.

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4. SENSIBLE DRINKING - key messages...

Eat something

Eating food with your alcohol helps you to pace yourself, and a full stomach will slow down the effects of the alcohol.

A drink with a meal only Try only drinking at home with your main meal. And not before or after you’ve eaten.

Pace yourself Enjoy a drink slowly. You don’t have to join in with every round. Take a break between drinks and have a low-calorie soft drink or glass of water in between, which will also help you stay hydrated.

Watch out for strength

Try drinking low-alcohol and alcohol-free drinks.

Watch your size You can still enjoy a drink, just have less. Try a smaller bottle of beer over a can or a small glass of wine rather than a large one. Wine glasses today are bigger than ever and can easily hold a third of a bottle.

A drink with a mixer Get more out of your drink by adding a low-calorie mixer to make it last longer.

Keep track

Statistics suggest that those of us who drink at home often pour much more than the standard pub measures of drinks, and are less likely to stick to the recommended daily limits. Try keeping a drinking diary – you can find one here: Drinking Diary

Hydrate

Alcohol is a diuretic, which means it will dehydrate you. Drink water regularly whether you’re drinking at home or in a pub.

A cup of tea or coffee When you get the urge to pour yourself a glass, switch on the kettle and enjoy a cuppa instead. The chances are you will not feel like an alcoholic drink afterwards. Drinking above the lower-risk guidelines and drinking heavily regularly on just one or two days a week can also be harmful to our health in the long term.

Take a break

Government advice is to have at least two alcohol-free days every week. It is ok to turn down alcohol.

Not everyone drinks alcohol: it’s OK to say no

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5. OUR HEALTH AND ALCOHOL

What is the problem with drinking over recommended limits?

The table below details some of these major alcohol-related health effects and some relevant

facts:

Liver disease

Fifth biggest killer in England and Wales, and is the only major cause of death still increasing year-on-year.

UK liver cirrhosis increased more than five-fold between 1970 and 2006. In contrast, in France, Italy and Spain the number of deaths decreased markedly and are now lower than those in the UK.

Digestive system

High intake of alcohol can have a negative effect on the digestive system, including gastritis (inflammation of the stomach lining), stomach ulcers, reflux leading to oesophagitis (inflammation of the lining of the food pipe) and pancreatitis (inflammation of the pancreas).

Cancer

Alcohol is a leading cause of mouth cancer, second only to tobacco. It is estimated that somewhere between 25% and 50% of cancers of the head and neck are a result of alcohol.

Up to 20% of breast cancer cases in the UK can be attributed to alcohol.

In an ongoing study of 500,000 people in ten European countries, it was found that for every two units consumed a day, the risk of bowel cancer increased by 8%.

Heart disease

Whilst drinking in moderation may offer some protection against heart disease for at risk groups i.e. men over 40 and women past the menopause, this should not be viewed as a green light to start drinking or increase consumption. There are better ways to protect against heart disease, like regular exercise and regularly eating fruit and vegetables.

The bones

Heavy drinking can contribute to osteoporosis (a disease which causes thinning of the bones)

Gout (swelling of the joints) can be exacerbated by heavy drinking, and it has been reported that this condition is becoming increasingly common in men in their twenties as a consequence of alcohol misuse.

Mental health

Alcohol is a depressant drug and prolonged drinking can lead to profound and long-lasting mood swings. Whilst low doses of alcohol appear to cheer people up, higher doses may cause psychological distress.

The World Health Organisation estimates that the risk of suicide when a person is abusing alcohol is eight times greater than if they were not.

Dementia

Excessive drinking is a risk factor for Dementia.

Someone regularly drinking more than the recommended levels of alcohol significantly increases their risk of developing dementias such as vascular dementia and Alzheimer’s disease. You don’t need to be an alcoholic to have this higher risk.

People with alcohol related dementias also tend to be middle aged, typically in their 50’s or younger and men more often than women. People who misuse alcohol also tend to suffer head injuries from falls or fights and often have a poor diet. These all contribute to alcohol dementia.

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Sexual and Reproductive

Health

When a woman drinks alcohol during pregnancy, the alcohol passes from her blood stream through the placenta and into the baby’s blood stream. When a woman is drinking regularly during this time, the alcohol can disrupt the baby’s normal development in the womb.

Drinking alcohol during pregnancy can affect: - the way the baby develops in the womb - the baby’s health at birth - the baby’s susceptibility to illness in infancy, childhood,

adolescence and adult life - the child’s ability to learn (learning difficulties).

The effects of drinking alcohol are most harmful for the baby when a woman drinks just before and during pregnancy.

When a woman cuts down or stops drinking at any point during pregnancy, it can make a difference to the baby. However, in some instances, once the damage has been done, this cannot be reversed.

Heavy drinking is often related to unprotected sexual intercourse, which may result in an unplanned pregnancy and sexually transmitted infection.

Alcohol lowers sperm count in men and fertility problems in women.

It is important that you share information with your healthcare professional(s) about your drinking. Depending on your situation, your healthcare professional will then be able to offer you appropriate information and support.

The Department of Health states that ...”pregnant women or women who are trying to conceive should not drink alcohol at all”. If they do choose to drink, to minimise the risk to the baby, they should not drink more than 1-2 units of alcohol once or twice a week and should not get drunk.

Early aging Dehydration and lack of proper sleep can wreck skin and hair. It expands

blood vessels, causing thread veins and other physical symptoms.

Sleep problems

Alcohol can help us nod off but even small amounts can prevent the deep sleep that we need to feel alert and refreshed.

Resources to support a health and wellbeing campaign can be accessed by following

embedded links in each poster (control + click to follow link).

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Alcohol and wellbeing

Many people believe that alcohol helps them to feel good. Unfortunately, the realities of a

hangover, difficulties at home (including in the bedroom) or at work, or a conviction for driving

under the influence show that very often this is far from the case.

There is also the issue that those who consume high amounts of alcohol are also vulnerable to

higher levels of mental ill health. Although drinking alcohol in the short-term it may provide

people with a relatively easy coping strategy for underlying

mental health issues such as stress, depression or anxiety,

the research suggests that long-term alcohol misuse is

damaging. Not only may it serve to worsen the very

symptoms it is being used to dampen, but it is associated

with a range of other mental health consequences. These

include depression, anxiety, suicide, risk-taking behaviours,

personality disorders and schizophrenia.

But plenty of non-alcohol related activities are known to boost how you feel. There is strong

evidence to suggest that incorporating the ‘5 ways to wellbeing’ (see following page) into your

everyday life will help you to feel good and function well. So instead of drinking to relax or wind

down after a stressful day, try doing something that includes one or more of the ‘5 ways’. It may

not work overnight, but the morning after the night before is likely to be a lot better!

24

The ‘5 ways to wellbeing’

Some suggestions to start you thinking:

For more information on using this resource go to:

http://www.wales.nhs.uk/sitesplus/888/page/61014

Or use the worksheets on the following pages to assess what you

are doing now and to plan your

“5 WAYS TO WELLBEING”

25

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26

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27

6. ALCOHOL FREE DAYS Most people do not drink alcohol every day, but if you do, try having some days off when you do

not drink at all. This is a simple way to cut your regular drinking. Just make sure you do not

increase the amount you drink on the other days.

‘Don’t let alcohol sneak up on you –

Have at least 2 alcohol free days each week’

Here are some tips to help…….. How to de-stress without alcohol:

Exercise is an excellent way to de-stress. Even a brisk walk can clear your head.

Try replacing an evening at the pub with another activity, maybe the cinema, theatre?

Having a nice warm soak in the bath will relieve tension from your body.

Get an early night to leave you fresh and alert the next day.

Have a mocktail or two… (see recipes on next page)

Access the below resources by following the embedded links (control + click to follow link)

28

Mocktails

VIRGIN CAIPIRINHA

1 lime, diced

1 lemon, diced

1 orange, diced

2 teaspoons sugar

Ginger ale

Place the fruit in a jug. Add the sugar and stir until juices are released from the fruit. Strain into ice-

filled tumblers and top up with ginger ale. Garnish with a sprig of mint.

EGG NOG

1 egg (use only lion marked eggs)

2 tablespoons caster sugar

½ pt milk

½ teaspoon vanilla extract

Beat the egg yolk with the sugar, vanilla and milk. Whisk the egg white until fluffy. Fold the egg

white into the yolk mixture. Serve in tumblers, sprinkled with a little cinnamon.

ON THE BEACH

¼ Honeydew melon (make sure it's ripe)

100 g raspberries

100 ml orange juice

10 ml lime juice

Grenadine

Lemonade

Blend the melon, raspberries, fruit juice and grenadine with a handful of ice. Pour into an ice-

filled highball and top with lemonade. Stir well. Garnish with a melon ball on a stick.

PINK PINA

2 parts pineapple juice

1 part coconut cream

1 part pink grapefruit juice

Blend the coconut cream and fruit juices together with ice. Pour into highball glasses and serve with

a slice of grapefruit

VIRGIN MARGARITA

1 part orange juice

1 part lime juice

3 parts sour mix (1 cup caster sugar, 2 cups water, 2 cups freshly squeezed lemon juice. Stir together)

Fill a cocktail shaker with ice. Add the ingredients and shake well.

Strain into an ice-filled cocktail glass.

To make a long drink, use a highball glass and top up with lemonade.

SAFE SEX

1 part peach juice

3 parts pineapple juice

3 parts orange juice

A squeeze of lime juice

Fill a cocktail shaker with ice. Add the ingredients and shake well. Strain into an ice-filled highball

glass. Garnish with a slice of lime and a strawberry.

TOOTHLESS SHARK

1 part lime juice

1 part grenadine

6 parts orange juice

Three-quarter fill a highball glass with orange juice. Add the lime juice and stir well.

Slowly pour in the grenadine.

Do not stir.

SHIRLEY TEMPLE.

Ginger ale

Grenadine

A wedge of lemon

Fill a highball glass with ice. Add a couple of dashes of grenadine before filling with ginger ale.

Squeeze the juice from the lemon wedge into the drink. Garnish with a cherry

29

7. HOME DRINKING There has been a noticeable shift towards drinking away from licensed premises in recent

years. Research carried out in Wales by Alcohol Concern in 2010 found that 50% of drinkers

said that they drank only at home, and an additional 21% drank equally at home and in the

pub.8

Why are we choosing to drink at home?

Affordability and availability of alcohol in

supermarkets and off licences – 46% of drinkers

in Wales have said they drink at home because it

is cheaper. This has led to the practice of ‘pre-

loading’ e.g. consuming alcohol at home before

going out to drink – research suggests that those

who ‘pre-load’ consume considerably more alcohol over the course of the night and are

2.5 times more likely to end up in a fight.8

Increasing popularity in home based entertainment e.g. television, electronic games

and listening to music

Home entertaining e.g. barbecues, parties, dinner with friends

Convenience – can easily help ourselves to drinks, can relax more at home, childcare

Safety - perception of alcohol related violence around bars and clubs

Stress release/reward

Introduction of the smoking ban

Lifecycle – too old to go to pubs and clubs

Home drinking issues:

Larger measures per drink

Unsupervised environment

Hidden impact e.g. Domestic Violence. Scientists have linked

aggression to the consumption of too much alcohol.9 More

worryingly scientists have also identified a strong link

between alcohol and domestic violence.10

Social isolation

30

Home drinkers tend not associate themselves with the images seen in the media of binge

drinking and anti social behaviour, but this does not mean they will not suffer from the same

effects of excessive alcohol consumption.

Home drinking is also seen as a solution to drink driving but we

could still be getting into our car the following morning over the

drink drive limit without even realising.

Taking risks

Whilst far fewer people are taking the risk of drink-driving at night, more are getting into their

cars in the morning, without realising they could still be over the legal limit to drive.11 Research

suggests people are failing to understand that just because you have been to sleep, it does not

mean you are no longer affected by alcohol.

Know our units

If we are thinking about driving the morning after we have been drinking, it is best to consider

how much we have drunk and how late into the night it was before we finished our last drink. It

is important to remember the strength of different drinks can vary greatly. There is no fail-safe

way to guarantee that all the alcohol we have drunk has left our system, so it is important not to

take risks. When we are under the influence of alcohol the skills we need for driving, such as

hand eye coordination, are impaired to some extent. We are more likely to have an accident

and be putting ourselves and others at risk.

Sleeping it off?

Whether it is okay to drive the next morning will depend on how much alcohol we have

consumed and if we have left enough time for our system to remove the alcohol. In general,

alcohol is removed from the blood at the rate of about one unit an hour - this does vary from

person to person. It can also depend on our size and gender, as men tend to process alcohol

quicker than women; how much food we have eaten; the state of our liver, and our metabolism

(how quickly or slowly your body turns food into energy).

We cannot speed up the process

There is a mixture of mechanisms at work when our body processes

alcohol. There is nothing we can do to speed up the rate alcohol leaves

our system - having a cup of coffee or a cold shower will not do anything at all to get rid of the

alcohol. They may make us feel slightly different, but will not have eliminated the alcohol in any

way.

31

What about our children?

Home drinking - simple cutting down ideas Alcohol Advice | Drinkaware - for the facts about Alcohol

1. Keep track of the alcohol units you’re drinking

Activity - unit calculator

2. Know what you’re buying

If you are a wine drinker a really easy way of cutting down on alcohol is to buy small (125ml)

glasses for the house rather than the large 250ml ones.

3. Home measures

It is worth buying an alcohol measure as there will be no more guess work involved and you will

be able to keep track of how much you are drinking.

Activity – unit measure cup

8. Drinkwise Wales Glance Sheet - Helping Yourself?

9. and 10. Institute of Alcohol Studies website. Binge Drinking and Europe report.

11. Department for Transport website. Reported road casualties in Great Britain: annual report 2014

Ever wondered who is the biggest influence on your kids? Your own habits will have a

big influence on how your child drinks or doesn’t, in the future, so set good examples and

stick to sensible alcohol consumption.

Talk and listen to your kids – talking builds up trust and helps you talk. Try and find out

how much your children really know about alcohol. Make sure any information you give

them is accurate, and let them know both the positives and negatives about drinking.

Keep an eye on it – when you are drinking at home or at a party, try measuring your

drinks rather than free pouring, so you can keep an eye on how much you have had to

drink. By using the unit measuring cups you can be sure how much you are drinking.

Don’t punish the children for your bad behavior – why should they suffer your

hangover? Make sure you are able to get out of bed on a Saturday morning and are fit to

drive so you can get them to swimming or football practice. You want to enjoy it as much

as they do.

32

8. Alcohol Concern “Dry January” Campaign

Banish the booze in January and make a healthy start to the new year by signing up to the

challenge of going booze free for 31 days.

It’s a great way of bringing up the topic of alcohol in a gentle, non-threatening way as it doesn’t

single anyone out. It is aimed at the huge number of people who are steadily drinking a bit too

much, too often, which accounts for around 10,000,000 people in the UK. Regularly drinking

over the recommended amounts can lead to health issues, but by giving up for just one month

you can have some positive benefits and have a chance to think about your drinking habits.

By taking on the challenge it’s your chance to lose weight, feel better, save money and make a

difference. With no hangovers you will find time and energy you never knew you had. So go on,

take time out, get thinking about your drinking and prove to yourself that you can say no to a

drink or two. Alcohol Concern will be there every step of the way, offering support, resources

etc.

This is your chance to ditch the hangover and prove to yourself that you can say no to a tipple

or two. To access support and a fundraising pack sign up at: http://www.dryjanuary.org.uk/

It is important to remember that this challenge is not a

medical detox or for those with dependency issues. If you

are worried about yours or someone else’s drinking please

speak to your GP or contact DAN 24/7 on 0808 808 2234.

33

ORGANISING

YOUR

CAMPAIGN

Stakeholders

Audience

Resources Vehicles of

Delivery

Evaluation

34

Tips for organising and running you’re alcohol awareness campaign/s:

Contact relevant partners/stakeholders to support activities

Ask your immediate team for help and assistance

Get approval for your campaign from your organisation and access any available funds to support implementation

Access campaign support materials form national and local alcohol organisations

If creating your own materials – proof read and develop bilingually

Map out settings to target with campaign

Distribute materials in advance of alcohol awareness week’s / months

Create a checklist for the campaign to aid planning and implementation

Always evaluate to help assess what has been achieved and to support the planning of future campaigns.

Methods of promoting the messages:

1. Internet/Intranet and Newsletter

A great way to spread the messages of the campaign is to regularly post information leading up to

and during the campaign on your internet / intranet page or via emails and/or newsletters.

2. Poster Displays

Most settings e.g. workplace, schools, post offices, community centres etc have areas where

posers / information / display boards can be placed.

See www.drinkwisewales.org.uk/downloads/ for other posters and leaflets, alongside those in this toolkit, to display.

Points to remember:

Make sure literature is well placed, somewhere where people will see it.

Remember that the successful campaigns rely on more than one method of promoting messages.

35

3. Engagement

A great way to engage with people is to set up a stall or a protected space which gives you a real

opportunity to start a conversation. An excellent way of bringing up the subject of alcohol use is to

engage individuals with an interactive tool.

See Alcohol Awareness Week Toolkit-2015.pdf for more activities alongside those in this toolkit.

Additional Resources (control and click to follow link):

4. Social Networking Twitter, Facebook and other forms of social media are effective methods of communication. You

could use these avenues to provide links to useful online resources in order to reinforce the

messages and to support people to change their relationship with alcohol.

See Alcohol Awareness Week Toolkit-2015.pdf for more ideas.

Follow Alcohol Concern Cymru: @ACCymru

Follow Drink Wise Wales: @DrinkWiseWales

5. Press Release

National campaigns are often suitable for demonstrating your organisation’s commitment to

improving the health and wellbeing of your workforce/community. Why not demonstrate your

commitment by including a press release from your organisation supporting the key messages

of the campaign

36

The Do’s and Don’ts of Alcohol Awareness Events

.

- Do be strategic about when and where you run them. Set up in a busy area such as a canteen or staff room, shopping centre, community event

- Make the stall / space appealing, eye catching and enticing;

- Do use positive language for campaigns and reinforce positive drinking messages. Do not preach to individuals.

- Do make them fun and engaging

- Do promote sensible drinking throughout the year

- Don’t just hand out leaflets. It is an important message so make an activity as engaging as possible.

- Raise the issue of alcohol consumption with individuals using some conversation starter tips in this toolkit

- Signpost to other resources that they could use to maintain their awareness of their own alcohol consumption, such as the drinks unit checker found on Change4Life Wales | Alcohol

- Points to remember:

- Remember to be creative and make your interaction appealing.

- Be sure that the links you provide are from a reliable source.

By getting involved in this campaign you will:

Provide a key opportunity to influence the wellbeing of the population of

Hywel Dda.

Enable your organisation/community to take a proactive approach to

health.

Contribute to National health improvement goals

37

Websites and contacts Change for Life:

Interactive website with tips, tools and advice on responsible drinking and ways to cut down

Change4Life Wales | Alcohol

Hywel’s House:

http://www.hywelddahb.wales.nhs.uk/healthy-wednesday

Drink Wise Wales:

Contains practical tips for responsible drinking and downloadable drinks diary

http://www.drinkwisewales.org.uk

Alcohol Concern Cymru:

Sign up to their newsletter to keep abreast of alcohol related developments in Wales

http://www.alcoholconcern.org.uk/

http://www.alcoholconcern.org.uk/projects/alcohol-concern-cymru

Public Health Wales

Contains data and information on alcohol misuse in Wales

http://www.wales.nhs.uk/sitesplus/888/page/71713

NHS choices:

Contains useful information on drinking and alcohol, impact of alcohol on health, and tips to cut down alcohol.

http://www.nhs.uk/Livewell/alcohol/Pages/Alcoholhome.aspx

Institute of Alcohol Studies:

IAS

Drink Wise, Age Well:

Drink Wise Age Well | Drink Wise Age Well

38

Services and specialist support

DAN 24/7:

Wales’ one stop shop for information, support and services relating to drugs or alcohol

www.dan247.org.uk

Wales Drug and Alcohol helpline:

0808 808 2234

Corporate Health Standard: http://www.healthyworkingwales.com Choices Young Persons Service: 01554 755779 DDAS: 03303 639 997

39

Evaluation Form

Please use this to tell us what you did around Alcohol Awareness

Name:

Organisation:

County:

Job Title:

1. How would you rate this toolkit and/or resources?

Excellent Good Fair Poor

2. Which resources did you use?

Yes No

‘Don’t let drink sneak up on’ you poster

‘What’s in your drink?’ poster

‘Don’t let drink sneak up on you’ A5 booklets

Alcohol Unit Wheels

Alcohol Unit Beakers

‘Dry January’ poster

‘Dry January’ leaflet

3. What campaign activities did you do?

Yes No

Poster(s) display How many displays? ..........

Leaflets and alcohol unit wheels display How many displays? ..........

Posted articles on the intranet and/or internet How many articles? ..........

Article in newsletter

Information stand held How many stands? ..........

Social networking employed

40

4. How many people would you estimate were exposed to the campaign?

5. Select a handful of participants at random and ask them the following questions:

6. Did you receive any comments or feedback on your campaign?

7. What other resources would you find helpful for running a future alcohol awareness

campaign?

Return evaluation form to Liz.Newbury-Davies@wales.nhs.uk or send to

Liz Newbury-Davies at Hywel Dda Public Health Team, Public Health Wales, Building 1, PO Box 108, St David's Park, Jobswell Road, Carmarthen, SA31 3WY

Question to ask Number

saying

yes

Number

saying

no

No.

saying

unsure

Are you aware of the ‘Don’t let drink sneak up on you –

Have at least 2 alcohol-free days a week’ Alcohol

Awareness Campaign that the organisation has run?

If no, do not ask any more questions

Having seen the campaign, do you understand why you

should have at least 2 alcohol-free days a week?

Do you think it’s important to have at least 2 alcohol-free

days a week?

Have you begun to think about changing the amount of

alcohol you consume as a result?

41

Produced by Hywel Dda Public Health Team, October 2015

This Toolkit has been adapted by Hywel Dda Public Health Team from the original developed by Cardiff and Vale Public Health Team using the toolkit developed in 2012 by Lee Parry-Williams, Helen Tunster and Josef Prygodzicz on behalf of Public Health Wales in

partnership with Alcohol Concern Cymru.