Alcohol

Alcohol and substance abuse

Alcohol is often included into the wider umbrella term of substance use, but whilst alcohol use is often a factor in those who use substances, it can be a standalone issue affecting all areas of the population.

When is alcohol use problematic?

Drinking becomes problematic when it affects a person's everyday life and or their health, even if this is not noticeably apparent. This includes physical and psychological dependence. Problematic drinking is often divided into the following three categories:

• harmful drinking
• dependent drinking
• binge drinking

What is harmful drinking?

Harmful drinking, or high-risk drinking, is when there is a pattern of alcohol consumption that causes mental or physical health problems, defined as the consumption of more than 35 units per week for women and more than 50 units per week for men.

What is dependent drinking?

Dependent drinking is when alcohol affects everyday life and a person is unable to function without alcohol. It is characterised by craving, tolerance, a preoccupation with alcohol and continued drinking despite harmful consequences.

What is binge drinking?

NHS England defines binge drinking as 'drinking heavily over a short space of time'. This equates to more than 8 units of alcohol during a short period of time for males, or more than 6 units for females which is based on the government's alcohol strategy published in 2021.

Unmet need

Unmet need is the estimated percentage of dependent drinkers who are not currently in structured treatment. It is calculated by using the estimated number of dependent drinkers and subtracting the number in treatment services over the past 12 months, and turning this into a percentage. 

This unmet need data only reflects those who are not in structured treatment (Tier 3) and some of these people may be accessing Tier 2 support services such as Alcoholics Anonymous.

Impact of alcohol use

Alcohol use has a considerable impact on individuals, families and communities, contributing to a range of physical, mental and social harms.  

Alcohol consumption is an underlying cause for more than 30 conditions, including being known to cause 7 types of cancer. However, alcohol is normalised across society and is very much a part of everyday recreational activities and celebrations. This makes it more difficult to identify and accept when drinking becomes problematic, particularly when physical health harms may not be apparent for years. People who seek treatment from treatment services can be stigmatised. The result is a high unmet need, with almost three quarters of those dependent on alcohol not engaged with treatment services.

Another issue that comes from alcohol use, is the associated anti-social behaviour, crime and violence. This can have an impact both inside and outside the home. In Stockton-on-Tees Town Centre, street drinking is an issue impacting on the real and perceived safety felt by residents and businesses.

Local authorities and wider partners have a role to play in reducing alcohol related harm. Due to stigma within society, there is a shift towards treating alcohol use as a long-term relapsing chronic health condition and using non-stigmatising language or approaches.

Health inequalities in alcohol use are both a cause and a consequence of deprivation, with those in most deprived areas experiencing the highest levels of harm.

There are 3 main risk factors for developing problematic alcohol use related harms later in life.

1. Persistent, multiple factors of disadvantage.

Substance use is used as a coping mechanism in response to stress or pain.

2. Adverse Childhood Experiences (ACE's).

ACE's can disrupt neurodevelopment, create coping mechanisms like self-medication, lead to mental health issues such as anxiety and depression, and increasing vulnerability to further trauma. Substances are used to escape distress, numb painful emotions, or as a form of self-harm, leading to a cyclical relationship where addiction can increase the likelihood of further trauma.

3. Parental substance use.

If a parent uses substances this creates a higher-risk environment where children may be more susceptible to developing their own substance use disorders.

Other risk factors (and therefore inversely, protective factors) related to alcohol use, which can increase individuals' chance of experiencing health inequalities and poor health outcomes are:

• people who attend nightclubs and festivals
• domestic abuse
• sexually exploited or sexually assaulted
• involved in sex work
• homelessness
• LGBTQ+
• not in employment
• children and young people looked after and or carers
• children and young people in contact with young offenders but not in secure environments
• poor mental health

There are two main ways of tackling alcohol related harm:

• policy and environmental interventions - these have an impact on the availability, accessibility, acceptability and affordability of alcohol, which influences buying habits and consumption levels
• treatment interventions

Increase treatment numbers and reduce unmet need for alcohol

Targeting at risk populations through the Peer Advocacy project and IPS (Individual Placement Support) helping those in structured treatment go back to work.

Recovery-based support at Stockton-on-Tees Recovery Service, including:

• harm reduction
• psycho-social interventions
• groups
• community detox
• referrals to residential rehab

Monitoring treatment numbers against agreed Office for Health Improvement and Disparities (OHID) targets and looking for ways to increase engagement with Stockton-on-Tees Recovery Service.

Promoting local treatment and support services, including outreach into the Wellbeing Hub.

Reduce alcohol related morbidity and mortality

Ways to reduce alcohol related morbidity and mortality are:

• through Alcohol Care Teams in North Tees hospital
• commissions on impatient detox bed across Hartlepool and North Tees Hospitals (based at North Tees)
• to promote and encourage uptake of fibroscans and associated pathways, within the inpatient detox service at North Tees and at GP surgeries
• working with partners on the complex lives workstream

Improvement of system pathways and service delivery

Ways to improve system pathways and service delivery are:

• respond to findings from the substance use Holistic Needs Assessment (HNA) and service review
• have local consultation with residents, organisations and commissioned services
• monitor local data and intelligence, responding to local need with an evidence-based approach

Together, a group of services provide clear priorities for preventing and tackling health and social harms related to substance use going forward. They are:

• The 2021 National Drug Strategy
• 2022 Substance Use Quality Commissioning Standards
• 2025 Health Needs Assessment
• service reviews
• stakeholder consultations

Although current support services are performing comparatively well in Stockton-on-Tees, supported by an increase in National Drug Strategy funding, the sector faces challenges relating to: 

• growing complexity
• risks
• stigma
• health inequalities

Another challenge the sector is facing is health harms associated with substance use particularly for communities experiencing prolonged use, several identified risk factors or comorbidities (illnesses or diseases that exist at the same time as another illness or disease in the same person), or severe and multiple disadvantage.  

This Joint Strategic Needs Assessment (JSNA) highlights opportunities to reduce harm, address inequalities and improve outcomes for those using and or experiencing harm due to substances. Taking forward recommendations will require a coordinated approach to ensure that support is accessible, effective and responding to current needs. 

 Stockton-on-Tees Recovery Service summary  

Stockton-on-Tees Recovery Service is currently delivered by Change Grow Live (CGL) and Recovery Connections, and includes a multi-disciplinary team of:

• recovery coordinators or coaches
• nurses
• mental health professionals
• social workers
• group workers
• specialist and targeted roles

Over 30% of the team have direct lived experience of substance use (and more with familial lived experience), which is recognised as good practice for effectively building relationships, engaging communities and supporting people into recovery.  

The service provides a range of treatment and recovery support options to both adults and young people through a mix of medical and Psychosocial Intervention (PSI), Harm Reduction approaches and access to residential rehabilitation.  

The service has dramatically reduced average waiting times from referral to assessment, and increased the proportion of clients successfully accessing treatment following referral, by introducing a full-time walk-in offer with same day prescribing in 2024. Stockton-on-Tees Recovery Service has also made significant progress against the 'From Harm to Hope' ambitions, including becoming a regional lead in some target areas. 

Stakeholder Engagement 2025  

In 2025, 4 focus groups and 4 surveys were completed with stakeholders to gather feedback around awareness, needs, challenges and support for substance use.   

Respondents to the surveys felt as though substances (including alcohol) were a significant problem in their neighbourhood, contributing to anti-social behaviour, crime and violence.

Responses were grouped into the 4 themes.

Awareness and education

There were concerns about young peoples' lack of awareness regarding drug and alcohol effects due to insufficient education. Communication campaigns, training and better promotion of support services are being suggested to improve overall knowledge and awareness.

Wider determinants of health

Issues like deprivation, social inequality, the COVID-19 pandemic, homelessness, and unemployment were associated with the potential of increasing substance use. Substance use was also identified as being something that was often used as a coping mechanism for trauma and mental health issues.

Alcohol licensing

Current alcohol licensing practices such as cheap alcohol and promotional offers appear to contribute to excessive alcohol consumption. Participants suggested that limiting early morning sales, capping purchase volumes, and raising the legal drinking age could help reduce excessive alcohol use.

Access to support

Most participants had not accessed existing alcohol support services and expressed barriers included negative experiences, stigma, and fear of social consequences. It was identified that there is a need for more community support and reducing stigma.

Substance Use Health Needs Assessment

The Substance Use Health Needs Assessment completed in 2025 provided over 50 specific recommendations for addressing local need, grouped into 3 themes. The 3 themes have been condensed into 11 overarching recommendations. 

Prevention

The recommendations are:

• reduce alcohol-related harm
• improve access and awareness
• strengthen, prevention and harm reduction
• engage communities and partners

Access to treatment and recovery

The recommendations are: 

• integrate and personalise support
• expand access and outreach
• strengthen health interventions

Intelligence and system improvement

The recommendations are:

• strengthen intelligence and data use
• improve access and integration
• promote inclusion and reduce stigma
• advance research and innovation

2024 Healthwatch report - Views & Experiences of People Accessing Drug & Alcohol Services.

Policies involving alcohol for further reading

1. Fit for the Future: 10 Year Health Plan for England on NHS website.
2. 10-year strategic plan for the drug and alcohol treatment recovery workforce (2024 to 2034)
3. Commissioning quality standard (CQS): alcohol and drug services (guidance and self-assessment tool)
4. National Institute for Health and Care Excellence - Alcohol-use disorders: diagnosis, assessment and management of harmful drinking (high-risk drinking) and alcohol dependence
5. NICE - Alcohol-use disorders: prevention
6. Alcohol strategy on GOV.UK website.
7. Local Government Outcomes Framework: priority outcomes and draft metrics

Regional policies

Read the Integrated Care Strategy Summary on the Better health and wellbeing for all webpage.

Local policies

We will reduce alcohol related harm in Stockton-on-Tees whilst ensuring that alcohol can be enjoyed responsibly.

Read the Stockton-on-Tees Joint Health and Wellbeing Strategy 2025 to 2030.

In Stockton-on-Tees Town Centre and Norton to reduce aggressive begging and alcohol related anti-social behaviour.

Visit the Public Space Protection Order webpage for more information.