Following prioritisation by the multidisciplinary Bedford Borough Alcohol Steering Group, the following actions were agreed as priorities:
1. To reduce alcohol related harm amongst children and young people ie:
- Complete a young people’s drug and alcohol services health needs assessment
- Ensure frontline workers are able to signpost young people who are misusing alcohol for specialist support
- Develop a better understanding of young people’s drinking behaviours
- Ensure teachers are informed about alcohol issues and pathways for support
Progress against actions:
- A substance misuse health needs assessment was completed in October 2013.
- Following the health needs assessment the children and young people’s drug and alcohol service (CAN YP) has been recommissioned with more emphasis on Tier 1 Early Intervention and Prevention work.
- Information has been developed and distributed to schools, children centres and other young people’s organisations which outlines where and how to report intelligence relating to proxy purchasing.
- Sensible drinking messages are included in the Aspire Magazine for local teachers and teaching staff, and the June edition was dedicated to alcohol.
- Delivered Identification and Brief Advice (IBA) training to a range of frontline workers supporting vulnerable children and young people.
- Secured funding for the part time Children’s Worker post to continue until March 2015. The post works with children and young people affected by parental alcohol misuse.
- Implement a school alcohol survey in January 2015 to better understand the drinking behaviours of young people and provide baseline information.
- Work with partner agencies to gather more robust data in relation to alcohol and children and young people, particularly alcohol-related hospital attendances and admissions.
- Develop and implement relevant actions that are identified through the Drugs and Alcohol Solutions Group.
Nationally, the number of children and young people aged 11–15 years who drink alcohol has fallen. In 2010, 13% of children surveyed aged 11-15 years in England drank alcohol in the last week which is the lowest level recorded since a peak of 27% in 1996. The proportion of pupils in this age group who have never drunk alcohol has risen in recent years, from 39% in 2003 to 55% in 2010 (Harker, 2012).
Alcohol misuse can be linked to a range of behaviours that may put a young person at risk of unsafe sex, violence and other criminal behaviours for example. In a survey of nearly 10,000 young drinkers aged 15-16 years (undertaken in North West England):
- 28% reported that they had experienced violence when drunk
- 13% had regretted alcohol-related sex
- 45% had forgotten things after drinking (NICE, 2012).
In 2009, the Chief Medical Officer issued guidance on alcohol consumption in children and young people advising that an alcohol-free childhood is the healthiest and best option. There are immediate health risks such as memory loss, risky behaviours, vomiting and alcohol poisoning. The recommendations included:
- Not drinking alcohol until the young person is at least 15 years.
- When consuming alcohol, 15 to 17 year olds should be in a supervised environment.
- 15 to 17 year olds should not consume alcohol on more than one day a week.
Evidence shows that young people who start drinking at an early age drink more, and more frequently, than those who delay their first alcoholic drink.
Under UK law, children and young people can consume different types of alcohol in different contexts, depending on their age. Young people aged 16 or 17 may consume alcohol with a meal when under adult supervision on licensed premises (NICE, 2012).
Alcohol consumed by young people is increasingly likely to be obtained from the home (Hughes, 2008). School aged children are more likely to be given alcohol than to buy it and most commonly by family or friends. In 2010, 26% of children surveyed aged 11-15 years who drank, were most likely to buy alcohol from:
- friends or relatives
- 16% bought it from someone else
- 16% bought it from an off-licence
- 12% bought it from a shop or supermarket (Harker, 2012).
One or more of the following factors are common among children and young people who use 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.(NICE, 2007)
Alcohol and parental influence
Parents and family play the most important role in children and young people understanding of alcohol as research suggests that drinking behaviour is influenced by the attitudes and behaviour of families. Children growing up in families where parents are dependent on drugs or alcohol are seven times more likely to become addicted adults (LGA, 2013). Young people are less likely to drink if their parents disapprove and more likely to drink if this is tolerated by their parents.
The misuse of alcohol by parents negatively affects the lives and harms the wellbeing of more children than does the misuse of illegal drugs. Yet too often, parental alcohol misuse is not taken as seriously, in spite of alcohol being addictive, easier to obtain, and legal. The effects of parents’ alcohol misuse on children may be hidden for years, whilst children try both to cope with the impact on them and manage the consequences for their families.
The number of children who are affected by/living with parental alcohol misuse is largely unknown. However, estimates suggest parental alcohol misuse is far more prevalent than parental drug misuse. There is a need for greater emphasis on parental alcohol misuse as distinct from other substance misuse.
It often takes a number of years before families affected by alcohol misuse seek support – mainly due to not recognising the alcohol problem in the first place. Given the widespread acceptance of a heavy drinking culture, confusion exists as to what amounts to a drinking problem. Evidence indicates alcohol problems tend to develop slowly over a long period of time.
Different levels of consumption (not just parents who are dependent drinker) and particular styles of drinking (such as binge drinking) may affect children. It cannot be assumed that higher levels of consumption equated to greater consumption. Also children living with parental alcohol misuse come to the attention of services later than children living with parental drug misuse.
A high proportion of young people in drug and alcohol services have other issues in their lives. This includes problems at school, experiences of poverty and marginalisation and lack of access to training and employment.
Young people who have offended
The link between substance misuse and offending behaviour is long established. Young people in the youth justice system have a high prevalence of substance misuse needs, even in comparison to other groups of vulnerable young people.
In many cases young people offend in order to fund their drug and alcohol use or they offend under the influence of drug and alcohol.
Children who are looked after and care leavers
There were a total of 1,900 looked after children in England who were identified as having a substance misuse problem during April 2011 to March 2012.
Young people aged 16-17 years are a group which are affected by homelessness, they are defined as a ‘priority need group.’ There is a well-established link between housing problems and substance misuse.
Many young people who misuse drugs and alcohol have multiple and co-occurring mental health problems. There is a correlation between substance misuse and self-harming behaviour.
A summary of key findings regarding the links between young people and risky behaviours include:
- Young people are more likely to have risky sex under the influence of alcohol.
- Young people are more likely to have sex at a younger age.
- Alcohol consumption is associated with teenage pregnancy.
- Alcohol is the main reason for having sex.
- Alcohol is a contributing factor for first sex and not using contraception.
A summary of key findings regarding the links between young people, alcohol and risky behaviours include:
- Young people are more likely to have risky sex under the influence of alcohol
- Alcohol consumption is associated with teenage pregnancy
- Alcohol is the main reason for having sex
- Alcohol is a contributing factor for first sex and not using contraception
- Young people are more likely to have sex at a younger age
What do we know?
Key facts, figures and trends
In 2011/12 there were approximately 20 alcohol specific hospital admissions for young people aged under 18 years in Bedford Borough. Alcohol specific conditions are those wholly related to alcohol eg alcoholic liver disease or alcohol overdose. During April to September 2012 there were 11 admissions, a decrease of 6 compared with the same period in 2011.
In comparison with the 2005/06- 2007/08 period, the rate of young people under 18 who are admitted to hospital is similar to the 2010/11-2012/13 period. The admission rate in the 2010/11-2012/13 period is similar to the England average.
*This data has been calculated using the total number of admissions occurring in an entire population and has not been adjusted to remove the effect of variables such as age or sex.
Commercial Regulation Team
Bedford Borough Commercial Regulation Team continues to provide intelligence-led response that is tailored to meet the needs of businesses and the communities. The priority outcomes ensure compliance and thereby reduce the supply of alcohol to those under age in Bedford Borough. Commercial Regulation will, where need is identified or assistance requested, continue to work with off and on licensed premises to reduce sales of alcohol to young people. This is done by providing the support to help licensees train staff in order to facilitate compliance.
Alcohol - Off Licence
Alcohol - On Licence
In 2013/2014, 24 test purchases (TPs) were made at Off Licence and On Licence in Bedford Borough where intelligence suggested there was a likelihood of illegal sales of alcohol. Only two failures occurred and these were dealt with by way of warning letter, follow up advisory visits and retest purchases. No premises failed twice. Additionally 10 people from businesses within the Borough attended a Trading Standards Institute accredited training session delivered by Borough Council Trading Standards Officers.
Challenge 25 is a retailing strategy that encourages anyone who is over 18 but looks under 25 to carry acceptable ID if they wish to buy alcohol. Introduced as Challenge 21 in 2006, Challenge 25 rolled out in the off trade in 2009.
Challenge 25 is not simply an ID scheme; there are several additional components that go into making the scheme effective by looking to raising the overall standards of those who sell alcohol.
These components include:
- Staff support
- Keeping records
- Clarity on acceptable ID
It is estimated that 850,000 people are trained in the application of Challenge 25 every year and around 11 million people have been challenged through Challenge 25 and similar schemes.
National and local strategies (current best practice)
CAN YP is a young person’s drug and alcohol treatment service covering Bedford Borough and Central Bedfordshire. CAN YP is part of the CAN partnership a drug, alcohol and homeless charity which has services across Bedfordshire and Northamptonshire.
CAN YP focus on the provision of information, education, advice and guidance on reducing harm and risk associated with substance misuse. The team consists of:
- service manager
- drug and alcohol workers
- specialist nurse practitioner
- children’s workers who offer therapeutic play sessions for children aged between 5-13 who have been or are affected by someone else’s drug or alcohol misuse.
CAN YP work with young people aged 5-18 who are affected either by their own or another’s drug and/or alcohol issues. Their sources of referrals come from social care, looked after children, CAMH, health, universal education, hostels, police and youth offending service
Although alcohol is the most commonly used substance, it is the second most commonly cited problem substance for those young people entering treatment in Bedford Borough. The most commonly used substance at referral to CAN YP is cannabis. This could be for a number of reasons:
- Professionals and young people not recognising that they can refer to CAN YP for alcohol support – there is a view that CAN YP is a drug agency.
- Professionals and young people often regarding excessive alcohol intake as ‘normal behaviour’. It is only when the alcohol intake becomes problematic or a drugs issue is identified, that concerns are raised.
The Community Alcohol Liaison Service (CALS) provides in-reach support and assessment within Bedford Hospital Acute Trust. There is a care pathway for adults aged over 18 years who attend hospital in relation to an alcohol problem. If a young person is referred to the CALS they will be automatically signposted to Plan B however to date, the CALS service has received no referrals for young people. Alcohol Concern recommends that alcohol related attendances at emergency Accident and Emergency should always result in the opportunity to access harm reduction programme/support.
Schools Health Education Unit - Substance Misuse School Awareness Study 2012.
A total of 2,654 students in 21 schools across Bedford Borough and Central Bedfordshire took part in the 2012 Substance Misuse School Awareness Study. This was carried out by the Schools Health Education Unit. 11 of the schools were in Bedford Borough. Participating students were all from years 8 and 10 ie aged 12/13 years and 14/15 years. Reports summarising the results of the study are expected by the end of March 2013.
25% of secondary aged pupils said that they have had an alcoholic drink in the last week. This figure increased with age; 18% of year 8 pupils said that they had drunk alcohol compared with 35% of year 10 pupils.
Comparisons between the Bedford Borough survey and the wider SHEU reference sample
- 36% of pupils said they ‘never’ drink alcohol compared with 50% of pupils in the wider sample.
- 10% of pupils said that if they drink alcohol, their parents/carers ‘never’ or only ‘sometimes’ know about this. This compared with 8% of the wider sample.
- 9% of pupils drank beer or lager in the previous 7 days. This compared with 6% of pupils in the wider sample. 6% of pupils drank wine compared with 3% of pupils in the wider sample. 7% of pupils drank alcopops compared with 4% of the wider sample.
- 7% of year 10 pupils bought alcohol from an off-licence in the last week. 3% of year 10 pupils said they bought it in a supermarket. 1% of year 8 pupils said they bought alcohol from an off-licence in the last week.
Health and Well Being Survey 2013
Four maintained upper schools in Bedford Borough took part in the Health and Well-being survey during the autumn term of 2012 with the majority of students being in years 9 and 10. A total of 1187 pupils took part. The survey was offered to Academies at a cost but none participated. Results were published in March 2013 with schools receiving an overall report and individual school report.
Answers are based on attitudes and perceptions of peers towards alcohol and other drugs.
- 17% thought that ‘drinking is never a good thing at any age’.
- 43% thought ‘Drinking at my age is OK as long as it doesn’t affect school work and other responsibilities’.
- The perception of peer’s attitudes to the previous statement was 35%.
In response to the question ‘Have you ever done the following and if so how recently?’
- 42% had never drank alcohol
In response to perceptions of their peers attitude to the same question results were as follows.
- 15% had never drank alcohol
In general, students perceived that more of their peers engage in risky behaviours than is actually the case – this is backed up by US and UK research.
The next Alcohol Survey with all schools in Bedford Borough will take place in January 2015.
Children and Young People’s Drug and Alcohol Health Needs Assessment 2013
Public Health completed a Health Needs Assessment in 2013 for children and young people’s drug and alcohol services. As part of this process two consultation workshops were held for local stakeholders. The workshops were attended by representatives from a range of local statutory and voluntary agencies. A brief questionnaire was circulated to professionals who were not able to attend. Responses were received from a number of services including MIND, the SEPT School Nursing team and the Education and Inclusion Support Team.
The workshops and questionnaires focused on what is working well in alcohol and drug treatment and what improvements could be made in the commissioning of services / support.
- Raise the profile of local provider and ensure stakeholders are aware that the service also supports young people misusing alcohol.
- Ensure substance misuse education is/continues to be delivered in schools.
- Ensure frontline professionals, particularly those working with the most vulnerable young people, are aware of relevant support services and how to refer / signpost to them.
- Take a whole family approach when addressing substance misuse issues.
- Ensure young people are able to access support for any mental health issues as this may be the source of their substance misuse.
Engagement and Development – consultation with young people
During July and August 2013, children and young people, through various methods and groups, contributed their views towards the Public Health consultation. The young people taking part included:
- 29 children and young people aged 9 to 19 years
- 5 young people with disabilities
- 4 young people in care
- 8 young people supported by social services “at risk” teams
- 11 young people from BME backgrounds
Where do you access information from?
- Police, friends, internet, Google, looked on website, Facebook, adverts, emails, mum, dad, carers, shops, street rangers.
- They all knew not to ask strangers.
- 1 person admitted they were on Facebook and that they were 12yrs old.
- They all knew that they should be 13+ to be on the site and they all had received the e-safety talk at school.
- From the computer
When asked how they would tell people about a service, they said…
- Talk to them face to face
- Speak to them in an assembly – you could target a group but the bad thing about assembly was that you can feel embarrassed if they ask you to come up at the end for information
- Write a sign
- Via a newsletter and give it out to everyone
- Through a TV advert
- If you get help from a service you can tell others at school but not your own school (like peer mentors) – although one person remarked that if it was at their own school it would be embarrassing and they would “chant” her name
- Via a free text number
When asked where they would go if they needed advice on drugs and alcohol for different people, they said:
1. If you were worried about your family?
- Dad, brother, I would tell them to stop; speak to the NSPCC, maybe the Police, rehab, GP; I’d be scared if they were using drugs; boyfriend / girlfriend; Childline; other family; my carer / social worker; other people’s parents; phone support; online chat
2. If you were worried about your friends?
- Mum; teacher; speak to friend involved; a health worker; maybe the Police; Plan B now I know they are there; an adult; their parents; their teachers; counsellor
3. If you were worried about drugs and alcohol in general?
- Police; teacher; head teacher; their own family; I would never do drugs; someone in school; ‘Talk to Frank’; telephone helplines; support groups
4. If you were worried in the summer holidays?
- Mum; another friend; other parents
Groups were also asked to think about the frequency of who they would go to. Different groups created different options. Core options included – Google, Twitter, Facebook, group work, friends and text.
The 2012 Government‘s Alcohol Strategy sets out proposals to clampdown on the 'binge drinking' culture. The strategy includes commitments to:
- Introduce a minimum unit price for alcohol which will target the cheapest products and help reduce drinking in those who drink the most
- Consult on a ban on the sale of multi-buy alcohol discounting
- Introduce stronger powers for local areas to control the density of licensed premises, including making the impact on health a consideration for this
- Pilot innovative sobriety schemes to challenge alcohol-related offending
The government has already legislated for a wide set of reforms to tackle binge drinking and the effect it has on individuals and communities. However, additional work is required to tackle drink-fuelled, antisocial behaviour and crime. In light of this, a national alcohol strategy consultation is currently taking place, seeking views on five key areas:
- A ban on multi-buy promotions in shops and off-licences to reduce excessive alcohol consumption
- A review of the mandatory licensing conditions, to ensure that they are sufficiently targeting problems such as irresponsible promotions in pubs and clubs
- Health as a new alcohol licensing objective for cumulative impacts. Licensing authorities can consider alcohol-related health harms when managing the problems relating to the number of premises in their area
- Cutting red tape for responsible businesses to reduce the burden of regulation while maintaining the integrity of the licensing system
- Minimum unit pricing, ensuring for the first time that alcohol can only be sold at a sensible and appropriate price
(Home Office, 2012)
In the event that new policy is released as a result of this consultation local action plans will be updated accordingly.
The new Public Health Responsibility Deal collective pledge (Home Office, 2012) announced it is to take one billion units of alcohol out of the market by 2015. This will be achieved through improving the choice available of lower strength products.
Companies have committed to helping their customers to drink within the guidelines by:
- improving consumer choice by lowering the strength of existing brands
- introducing new lower strength products
- encouraging their customers to switch to lower unit drinks rather than similar drinks with a higher unit content.
Estimates suggest that in a decade, removing one billion units from sales would result in:
- almost 1,000 fewer alcohol related deaths per year
- thousands of fewer hospital admissions and alcohol related crimes
- substantial savings to health services and crime costs each year (Home Office, 2012).
National outcomes, as identified in the Government’s Alcohol Strategy, include:
- Changes in attitudes so that people think it is not acceptable to drink in ways that could cause harm to themselves or others
- Reduction in the amount of alcohol-fuelled crime, especially violent crime
- Reduction in the number of adults drinking above the NHS guidelines
- Reduction in the number of people binge drinking
- Reduction in the number of alcohol related deaths
- Sustained reduction in both the numbers of 11-15 year olds drinking alcohol and the amounts consumed
In October 2012, a local government public health briefing paper was published. It summarises NICE (National Institute for Health and Clinical Excellence) recommendations for local authorities and their partner organisations, on how to reduce the harm caused by alcohol. It suggests that local authorities:
- Can influence where and when alcohol is consumed or sold
- Can enforce laws on underage sales
- Have an important role in ensuring licensed premises operate responsibly and collaborate to reduce alcohol related harm
- Have a role in promoting and advising people about sensible drinking
- Have responsibility for commissioning alcohol prevention and specialist treatment
- Have responsibility for health checks which, from April 2013, will include an assessment of how much alcohol someone drinks.
Alcohol Education in Schools
NICE recommendations for schools include the following:
- Alcohol education should be an integral part of the school curriculum and should be tailored for different age groups and different learning needs.
- A 'whole school' approach should be adopted, covering everything from policy development and the school environment to staff training. Parents and pupils should be involved in developing and supporting this.
- Where appropriate, children and young people who are thought to be drinking harmful amounts should be offered one-to-one advice or should be referred to an external service.
- Schools should work:
- with a range of local partners to support alcohol education in schools
- ensure school interventions are integrated with community activities
- find ways to consult with families about initiatives to reduce alcohol use.
What are the key inequalities?
Alcohol is strongly linked to health inequalities. It has an inverse social gradient which means that consumption increases as income rises; the proportion of people exceeding the sensible drinking guidelines also rises in line with income.
Children from higher income households in England appear to be at greater risk of some types of adolescent alcohol problems and these risks appear different in girls compared to boys. Childhood social advantage may not generally be associated with healthier behaviour in adolescence (Melotti et al, 2012)
Research exploring risk, protective factors and resilience to substance (including alcohol) misuse, indicates that some young people are particularly vulnerable including:
- frequent truants
- young people excluded from school
- young offenders,
- looked after children
- care leavers
(Home Office, 2007; NHS Information Centre, 2008).
Among men and women aged 16-64 years, those in professional and managerial households are most likely to have drunk alcohol in the previous week. Those in semi-routine and routine occupations are the least likely. This is also true in the proportions drinking on 5 days or more in the previous week. Similarly, those working are more likely to drink and binge drink than those who are unemployed and economically inactive (Harker, 2010).
People with lower socioeconomic status are more likely to abstain altogether. But if they do consume alcohol they are likely to suffer greater harm from drinking than those from higher socioeconomic groups. They are more likely to:
- Have problematic drinking patterns and dependence
- Die, in part, as a result of alcohol
- Die of an alcohol specific cause
- Be admitted to hospital due to an alcohol use disorder
There is additional evidence to suggest that the following groups may be at higher risk of alcohol misuse:
- Lesbian, gay and bisexual people – a number of small studies in the UK suggest that there are higher levels of alcohol misuse among this group of people (BMA, 2008).
- Transgender people can at risk of alcohol abuse, as well as depression, self-harm and substance abuse.
- Short term prisoners – Brooker et al (2009) found that 44.4% of short term prisoners were at risk of alcohol abuse. This is five times greater than the percentage of people misusing alcohol within the general population.
- Minority ethnic groups – particularly young people belonging to minority ethnic groups with strong religious ties that forbid drinking, or are less tolerant of drinking among women, may hide their drinking for fear of repercussions and bringing shame on their families. This is evident among some young people belonging to Muslim, Sikh and Hindu religions (Hurcombe et al, 2010).
- People with mental health issues.
Ethnicity and alcohol
Most minority ethnic groups have higher rates of abstinence, and lower levels of frequent and heavy drinking compared to the British population as a whole, and to people from white backgrounds. However over time, generational differences may emerge. There is some research to show that patterns of drinking in second generation minority ethnic groups may start to resemble the drinking habits of the general population.
Drinking patterns vary both between and within minority ethnic groups. For example:
- Abstinence is high amongst South Asians, particularly those from Pakistani, Bangladeshi and Muslim backgrounds. However Pakistani and Muslim men who do drink, do so more heavily than other non-white minority ethnic and religious groups.
- People from mixed ethnic backgrounds are less likely to abstain and more likely to drink heavily compared to other non-white minority ethnic groups.
- People from Indian, Chinese, Irish and Pakistani backgrounds on higher incomes tend to drink above recommended limits.
- Frequent and heavy drinking has increased for Indian women and Chinese men.
- Drinking among Sikh girls has increased, whilst second generation Sikh men drink less than first generations.
The reasons for these variations in drinking patterns amongst minority ethnic groups are varied. Patterns among some first generation minority ethnic groups resemble those from their country of origin. Stress associated with migration among first generations has also been linked with increases in drinking, particularly among white ethnic groups. The experiences of moving to a new country can be affected by a number of factors including access to education and employment, changes to socio-economic status and peer influences and lifestyle choices.
In general, studies suggest that abstinence and low levels of drinking among non-white ethnic groups are associated with:
- a strong ethnic identify
- strong family and local community ties
- continuing links with the host country
- maintaining religious beliefs.
Hurcombe et al, 2010
What are the unmet needs/gaps?
- Lack of awareness amongst stakeholders that local young people’s service also supports young people misusing alcohol.
- Limited prevention/ early intervention work in schools around alcohol.
- Frontline professionals (particularly those working with the most vulnerable young people) should receive relevant training around local support services and how to refer / signpost to them. As well as training around identifying alcohol issues in young people.
- A whole family approach should be taken when addressing alcohol issues.
- Limited access to services for young people experiencing mental health issues
- Ensure young people drinking at increasing or higher risk levels are identified early
- Take a whole family approach when addressing alcohol misuse.
- Ensure young people who are affected by their parent/carers drug and alcohol misuse are identified early and engaged with.
- Ensure messages are relevant and consistent.
- Professionals with a safeguarding responsibility for children and young people aged 10-15 years who are thought to be at risk of drinking alcohol* should determine an appropriate course of action.
- Deliver young people’s IBA training to develop staff competencies in the identification of alcohol.
- Ensure alcohol education programmes complement the Personal, Social, Health, Education (PSHE) provided in schools and other education settings.
- Ensure education is tailored for different age groups and takes different learning needs into account.
- Increase awareness of how the media, advertisements, role models and the views of parents, peers and society can influence alcohol consumption.
- Find ways to consult with families about initiatives to reduce alcohol use. Involve them in commissioning decisions, the design of health services and campaigns.
*Young offenders, children who are looked after, young people not in education, employment or training (NEET), excluded young people and care leavers. (NICE Public Health briefing paper for local authorities, 2012).
This chapter links to the following chapters in the JSNA:
DeMartini, K, Palmer, R, Leeman, R, Corbin, W, Toll, B, Fucito, L and O'Malley, S 2012, 'Drinking Less and Drinking Smarter: Direct and Indirect Protective Strategies in Young Adults' in journal Psychology Of Addictive Behaviours, pp 1-12
Department of Health (2007) Tackling health inequalities: 2007 status report on the Programme of Action. London: The Department.
Department of Health and National Treatment Agency for Substance Misuse (2012) Statistics from the National Drug Treatment Monitoring System – Statistics relating to young people England, 1 April 2011 – 31 March 2012. Manchester: National Drug Evidence Centre.
Harker, R. (2012) Statistics on Alcohol. London: House of Commons Library
HM Government (2012) The Government’s Alcohol Strategy. London: The Stationery Office.
Hughes, K. et al (2006) Youth violence and alcohol in North West Public Health Observatory. (2012) Protecting people Promoting health – A public health approach to violence prevention for England.Liverpool: The Centre for Public Health.
Hurcombe, R, et al (2010) Ethnicity and alcohol: a review of the UK literature. York: Joseph Rowntree Foundation.
Institute of Alcohol Studies (2010) Adolescents and Alcohol – IAS Factsheet. Cambridge: IAS
James, C (2011) Drug prevention programmes in schools: What is the evidence? London: Mentor – The Drug and Alcohol Protection Charity.
LAPE (2012) Local Authority Profiles. Available at: http://www.lape.org.uk/
Local Government Association (2013) Tackling drugs and alcohol. London: Local Government Association.
Marmot, M. (2010) Marmot Review – Fair Society, Healthy Lives: A Strategic review of Health Inequalities in England.
Melotti, R. Lewis, G., Hickman, M., Heron, J., Araya, R. and Macleod, J. (2012) ‘Early life socioeconomic position and later alcohol use: birth cohort study’ in journal Addiction
National Institute for Health and Clinical Excellence (2007) School –based interventions on alcohol.Available at www.nice.org.uk/nicemedia/live/11893/38402/38402.pdf (Accessed: November 2012)
National Institute for Health and Clinical Excellence (2012) Local government public health briefings – Alcohol. Available at http://publications.nice.org.uk/phb6 (Accessed: 31 October 2012)
Schools Health Education Unit (2012) Supporting the health of Young People in Bedford Borough Exeter: SHEU