2 Public health need and practice

Alcohol use among children and young people is growing faster than the use of any other drug in the UK and it causes the most widespread problems. Alcohol is also the least regulated and most heavily marketed drug (Advisory Council on the Misuse of Drugs 2006).

The number of children and young people aged 11–15 who drink alcohol has fallen since 2001. However, those who do drink alcohol consume more – and more often (HM Government 2007). In 2006, 21% of those aged 11–15 who had drunk alcohol in the previous week consumed an average 11.4 units – up from 5.3 units in 1990. Drinking prevalence increased with age: 3% of pupils aged 11 had drunk alcohol in the previous week compared with 41% of those aged 15 (The Information Centre for Health and Social Care 2007).

Children and young people aged 11–15 who regularly smoke or drink are much more likely than non-smokers and non-drinkers to use other drugs (Advisory Council on the Misuse of Drugs 2006).

In 2003 in the UK, 8% of young people aged 15–16 reported having unprotected sex after drinking alcohol (11% females, 6% males). Eleven per cent of all those in this age group who had (unprotected or protected) sex as a result of drinking alcohol subsequently regretted it (12% females, 9% males) (Hibbell et al. 2004).

In 2000 in Britain, nearly 14% of young people aged 16–19 were estimated to be either mildly (12.4%) or moderately (1.4%) dependent on alcohol, that is, they scored more than 4 on the 'Severity of alcohol dependence questionnaire' (SAD–Q) (Singleton et al. 2000).

An analysis of data from the 1970 British birth cohort study (Viner and Taylor 2007) found that 17% of adolescent binge drinkers were dependent on alcohol at age 30 (compared to 11% of the remaining cohort); 43% exceeded the recommended weekly limits (compared to 30% of the remaining cohort); 24% were taking illicit drugs (compared to 16% of the remaining cohort).

Regular, heavy alcohol consumption and binge drinking are associated with physical health problems, anti-social behaviour, violence, accidents, suicide, injuries and road traffic accidents. Alcohol consumption can also have an impact on school performance and crime rates (British Medical Association 2007).

Excessive alcohol consumption among adults is associated with 15,000 to 22,000 premature deaths annually. In 2005, 4160 people in England and Wales died from alcoholic liver disease (HM Government 2007).

The risk of liver disease and conditions such as high blood pressure, coronary heart disease and stroke are significantly higher for adults who exceed the recommended limits on alcohol consumption (HM Government 2007).

In 2005–06, over 2500 children aged 0–14 years were admitted to hospital in England with a primary, alcohol-related diagnosis (The Information Centre for Health and Social Care 2006).

Factors that may influence alcohol use among children and young people

One or more of the following factors are common among children and young people who use drugs of any sort, including alcohol:

  • Drug or alcohol misuse by parents or older siblings.

  • Family conflict or poor and inconsistent parenting.

  • Poor school attendance and poor educational attainment.

  • Pre-existing behavioural problems.

  • Living with a single or step-parent, being looked after or homeless.

(Adapted from Institute of Alcohol Studies factsheet 2007.)

Policy background

Numerous government strategies and policies aim to prevent or reduce alcohol use among children and young people under 18 (see below).

  • The 'Alcohol harm-reduction strategy for England' (Prime Minister's Strategy Unit 2004) and its update (HM Government 2007) say that schools should provide alcohol education as part of their citizenship, PSHE and PSHE education programmes. It is acknowledged that information-giving alone is unlikely to reduce consumption and interactive programmes are encouraged to develop the individual's personal skills.

  • 'Drugs guidance for schools' (Department for Education and Skills 2004) states that drugs education is part of the statutory national science curriculum and should start in primary school. It also recommends that drugs education should be delivered in PSHE, PSHE education and citizenship classes.

  • Alcohol education is an integral part of PSHE and PSHE education which, in turn, is a core part of the National Healthy Schools Programme. The National Healthy Schools Programme adopts a 'whole school' approach to physical and emotional wellbeing ('National healthy school status – a guide for schools' [Department for Education and Skills 2005]).

  • 'The drugs strategy' (Home Office 2002) recognises the important role that schools can play in preventing and reducing drug use and its related harms.

  • 'Choosing health: making healthier choices easier' (DH 2004a) stresses the need to raise awareness of the health risks associated with alcohol.

  • 'The national service framework for children, young people and maternity services. Core standards' (DH 2004b) states that all agencies should identify children and young people at risk of misusing drugs or alcohol and provide them with prevention and treatment services.

  • Local authority children's services, health bodies (including PCTs), schools, the police and other agencies are expected to develop and deliver the 'Children and young people's plan' by defining how the five outcomes from 'Every child matters' will be met. This is part of their statutory obligation to cooperate to improve the wellbeing of children in their area (HM Government 2004a; 2004b).

  • 'Every child matters: change for children. Young people and drugs' (HM Government 2005) sets out how local authorities should prevent and reduce drug use among children and young people. Average alcohol consumption among children and young people is identified as a DH outcome indicator in 'Every child matters: change for children' (HM Government 2004b)

  • The number of young people misusing substances (including alcohol) is one of the new set of national indicators that will be used to monitor the performance of local authorities and their partners. This follows publication of the 2007 comprehensive spending review (HM Treasury 2007) and 'The new performance framework for local authorities and local authority partnerships' (Department for Communities and Local Government 2007). From April 2008, local authorities will be required to negotiate local area agreements (LAAs) comprising up to 35 targets (plus statutory targets for early years and educational attainment) derived from this set of indicators. (They will also be free to agree local targets reflecting important local concerns.)