17 BRIEFING PAPER 1 DISCUSSING DRUGS AND ALCOHOL WITH

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17 BRIEFING PAPER 1 DISCUSSING DRUGS AND ALCOHOL WITH
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The case for using Alcohol Brief Interventions with Young people under the age of 16

Briefing Paper 1: Discussing Drugs and Alcohol with Young People

The case for delivering Alcohol Brief Interventions to young people

The evidence base for the effectiveness of Alcohol Brief Interventions (ABIs) is substantial, with a WHO¹review of 32 alcohol strategies and interventions finding them to be among the most effective alcohol policies. Most of this evidence base has been derived from studies conducted in primary care settings.

In 2008, the Scottish Government set a national ABI ‘HEAT’ (Health Improvement, Efficiency, Access and Treatment) target, tasking Health Boards to deliver 149,449 ABIs in primary care, A&E and antenatal care settings by March 2011. This was achieved and extended further to help local Health Boards embed screening and ABIs into routine practice, and to support their development in ‘wider’ settings. A scoping study conducted by NHS Health Scotland in 2012 found that one of the most active wider settings where ABIs are being delivered in Scotland is within services for young people.²

Although the HEAT target only related to the delivery of alcohol brief interventions to people aged 16 and over, various studies which have looked at the effectiveness of delivering alcohol brief interventions to young people appear to support the efficacy of this approach.^3,4,5Research studies have also highlighted that it is both feasible and acceptable to deliver ABIs in non-health, young people settings.⁶

An alcohol brief intervention is typically a short motivational interview by practitioners in which the costs and benefits of drinking are discussed, along with information about health risks.¹

The DH Guidance on the Consumption of Alcohol by Children and Young People (2010) recommends that where appropriate, brief, one-to-one advice on the harmful effects of alcohol, how to reduce the risks and where to find sources of support should be offered to children and young people in schools. It suggests that motivational-type brief interventions can be used as one-off interventions, or to facilitate engagement with more structured substance misuse treatment.⁷

The Scottish Youth Commission on Alcohol recommendations supports the core components of the Getting It Right for Every Child (GIRFEC) approach. This approach requires all services for children and young people to adapt their systems and practices to improve how they work together to support children and young people and to encourage early intervention.⁸

Several health board areas across Scotland are planning or delivering some form of Alcohol Brief Interventions for young people across various settings. Training delivery mainly focuses on NHS Health Scotland’s Alcohol Brief Interventions training manual or an adaptation of this. The model chosen in NHS Highland is also an adaptation of this training manual but it is designed to be used by a range of practitioners working with young people, in keeping with the recommendations in the DH document Guidance on the Consumption of Alcohol by Children and Young People (2010) which states:

“Professionals from health, education, social care and criminal justice agencies need to be able to identify, assess and, where necessary, appropriately refer young people experiencing alcohol-related problems.” ⁷

The National Institute for Health and Clinical Excellence (NICE) guidelines: Alcohol-use disorders: preventing the development of hazardous and harmful drinking (2010) ⁹, recommends that children and young people aged 10 -15 years who are thought to be at risk from their use of alcohol should be routinely assessed. Assessment should be carried out by any professional with a safeguarding responsibility for children and young people and who regularly comes into contact with this age group.

The case for delivering Brief Interventions to young people using other substances

Approaches based on early screening of young people’s drug use and brief behaviour change interventions, such as motivational interviewing, have been evaluated in the United Kingdom and elsewhere.^10,11Evidence suggests that it is feasible to deliver brief one-to-one interventions such as motivational interviewing to young drug-users in a wide range of settings, such as youth centres, further education colleges, general practitioners’ surgeries and ‘emergency rooms’.^12,13,14 NICE guidance ¹⁵ and RCGP practice standards¹⁶ have now been published which promote Brief Interventions and a Motivational Interviewing approach to reduce risk for this group. Both publications target all staff in contact with young people aged 18 or under (in universal, targeted, and specialist services) across health, social care, education, youth justice system, and the voluntary and community sector. They aim to support the identification of young people not seeking treatment but who may be at risk of substance misuse problems.

In health settings Brief Interventions, involving assessment and feedback using a motivational approach and provision of information about harm reduction, has been recommended as a framework for conducting clinical interviews with users of new recreational drugs such as Mephedrone and GHB. ¹⁷

The case for delivering brief Interventions to young people who smoke

Brief interventions can generate quit attempts and provide motivation to quit, or encourage smokers to think about quitting in the future. Therefore, brief interventions are an important part of a smoker’s pathway to stopping smoking ⁴⁷.

Brief interventions by non-specialist staff are effective in triggering quit attempts and encouraging smokers to use the smoking cessation services ⁴⁷. Using these services will give the best chance of stopping smoking and smokers should be directed towards local services as part of a brief intervention. In Highland, details of local services can be found at www.smokefreehighland.co.uk. All pharmacies in Scotland also provide a smoke free service. Plus, there is a national helpline and website with web chat, 0800 84 84 84 or Quit Your Way (https://www.nhsinform.scot/care-support-and-rights/nhs-services/helplines/quit-your-way-scotland).

As the evidence of what is effective for young people is still emerging, best practice is not yet established ⁴⁸. Indeed, a recent Cochrane review ⁴⁹ highlighted that there is no robust evidence for any young people orientated intervention, and so called for further trials including looking specifically at brief interventions, as they are often used as the control group to more complex interventions.

Intensive intervention is more effective than brief intervention (which is why it is recommended to direct people to specialist service). However, brief interventions for smoking cessation among young people have resulted in as much smoking reduction as more intensive interventions ⁵⁰, have had a positive impact on plans to quit, increased number of quit attempts ⁵¹, and achieved short term smoking cessation ⁵².

Brief interventions to help people stop smoking are both very cost-effective and effective, and thus recommended ⁴⁷. In addition, the updated Scottish tobacco control action plan states that any young person who smokes should be offered accessible support to help them to become tobacco-free ⁵³.

The extent of the problem - Alcohol

The 2013 Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) ²⁰ reported that in the NHS Highland area 32% of 13 year olds and 72% of 15 year olds had had an alcoholic drink. The proportion of 13 year olds in Highland who have ever had an alcoholic drink is similar to the national average. However, the proportion of 15 year olds in Highland who have ever had an alcoholic drink remains higher than the national average (72% in Highland compared with 70% nationally). SALSUS 2015 ⁴⁴ reports 28% of 13 year olds and 66% of 15 year olds have ever drunk alcohol, continuing the national reduction of recent years.

Compared with 2010 ¹⁹, there has been a notable decrease in the proportion of 13 year olds who had ever had an alcoholic drink (from 46% in 2010 to 32% in 2013) and a smaller decrease in the proportion of 15 year olds who had ever had an alcoholic drink (from 83% in 2010 to 72% in 2013).

In Highland, 3% of 13 year olds and 16% of 15 year olds reported that they usually drink at least once a week (including those who drink ‘almost every day‘ and ‘about twice a week‘) ²⁰.

While measures suggest that overall the consumption of alcohol by those who are drinking has fallen slightly within both age groups, no accurate figure can be given for the percentage drop as the method used for calculating this information has changed.

Spirits are the most popular choice followed by beer, lager and cider in 13 year olds. Amongst 15 year olds beer, lager and cider are the most popular drinks consumed, followed by spirits.

Young people’s drinking varies considerably between the ages of 12 and 17, with 14 and 15-year-olds marking a key group whose members are keen to test their limits with alcohol and drink to intoxication but who do not necessarily enjoy the process of drinking. Generally they dislike the taste of alcohol and the amount which needs to be drunk to reach intoxication. Designer drinks however have particular characteristics that meet the needs of this group by minimizing the costs and maximizing the effects of drinking. The brand image of designer drinks matches the perceptions and expectations of 14 and 15-year-old drinkers in particular. Furthermore, consumption of these drinks is linked to heavier drinking.¹⁸

Over the last decade, public concern about the impact of alcohol on health and society has steadily mounted. The 2015 Scottish Health Survey of the adult population stated that 36% of men and 17% of women exceeded the recommended weekly alcohol guidance of 14 units⁴². Similarly particular concern has centred on the level and pattern of drinking among children and young people and its consequences on health, crime, violence and antisocial behaviour. It is hoped that through delivery of ABIs to young people this trend may be changed.

Scotland has an underage drinking problem. In Scotland, 22% of 15 year olds report first drunkenness at age 13 or younger. This is higher than the rest of the UK, most other European countries and the US. The countries with higher prevalence than Scotland are Lithuania (highest), Romania, Greenland, Latvia and Estonia ⁴⁶. The Scottish Government is committed to tackling it through new laws and regulations, public education and training for staff.

The extent of the problem - Other Substances

In relation to other substances, a comparison of the SALSUS of 2010 ¹⁹ and 2013²⁰ showed the NHS Highland area prevalence rate for 15 year olds who had taken illicit drugs in the last month has decreased since 2010 from 13% to 9%. This is the same as the national average in 2013. A similar trend was shown for 15 year olds reporting illicit drug use over the past year. National figures decreased from 19% to 16%; local figures decreased from 20% to 14%. 3% of 13 year olds confirmed that they had ever used or taken drugs in 2013, lower than the national figure of 4%. SALSUS 2015 ⁴⁴ shows drug use amongst 13 year olds and 15 year old girls remains stable, with a small increase in 15 year old boys who had taken drugs. Figures from the survey show frequency of drug use increases with age. This was confirmed by the Highland Lifestyle Survey (2015).²¹ No differences showed between boys and girls. Cannabis was the most frequently used substance, followed by psychedelics and stimulants.

For the percentage of 13 and 15 year olds who have ever been offered drugs, the NHS Highland area prevalence rate continues to be slightly lower than the national average.

As of 30^th April 2013, 86 young people in Highland were accessing one to one support from Youth Action Service substance misuse workers. In 2011/12 drug related A&E admissions across an age spread from 7 – 18 years totalled 102, with a breakdown of 72 females and 30 males. ²²

The teen brain is a work in progress, making it more vulnerable than the mature brain to the physical effects of drugs. The potential for developing substance abuse and dependence is substantially greater when an individual’s first exposure to alcohol and illicit drugs occurs during adolescence than in adulthood.

Most young people do not use illicit drugs or alcohol, and among those who do only a minority will develop serious problems; however the UK has amongst the highest rates of young people’s cannabis use and binge drinking in Europe. ²³

[It is worth noting that the phrase ‘binge drinking’ has been replaced in order to overcome and avoid negative stereotypes, connotations and judgement associated with this term. The World Health Organisation (WHO) describes heavy episodic drinking, or HED, which is defined as drinking at least 60 grams or more of pure alcohol on at least one occasion in the past 30 days ⁴⁵. 60 grams of pure alcohol equates to 7.5 units of alcohol.]

The extent of the problem – Smoking

In Highland the rate of regular smokers aged 13 and 15 fell from 2% and 14% in 2010 respectively, to 1% and 10% in 2013. These are the lowest rates since monitoring began in 1982. The percentage of occasional smokers is also low; 1% of 13 year olds, and 5% of 15 year olds. However, the percentage of young people who felt it was ‘ok’ for someone their age to try smoking to see what it is like rose between 2010 and 2013, to 23% among 13 year olds, and 53% among 15 year olds⁴⁴. This figure is higher in Highland than Scotland overall, as is the rate of 15 year olds regularly smoking.

Regular smokers were asked about the source of their tobacco. The majority of young people get someone else to buy for them, or are given tobacco by friends, family or carers. The majority of regular smokers had smoked for more than one year, had tried to quit, and would find it hard to quit. 46% would like to quit⁴⁴.

In the 16-24 age bracket, 21% of people smoke. Very few adults begin smoking, with the majority of smokers beginning before the age of 16 ⁵⁴.

The Scottish Government is committed to achieving a smoke free generation by 2034 ⁵⁵ and has set out a series of actions to achieve this ^55
53.

Why do young people drink?

“It’s the party atmosphere alcohol can bring”; “it gives you confidence to meet new people”; “it loosens your boundaries a little bit, so you feel less restricted”.

More importantly, from the point of view of harm, why do young people get drunk? Because most of the problems related to young people's drinking are from intoxication, not just from taking a few sips or one drink.

Adolescence is seen as a period of experimentation and identity formation. Part of this developmental process includes seeking new sensations and taking at least some risks, with a particular focus on practicing what is perceived as adult behaviours which serves as markers of adulthood.

Motives for experimenting with drinking and intoxication vary. Motives which are commonly mentioned in the literature include rebellion, sensation-seeking, providing pleasure, alleviating boredom, satisfying curiosity, facilitating social bonding, attaining peer status, or as an escape/coping mechanism. These motivators suggest drinking is a functional behaviour; however it may also have a symbolic significance.

When young people drink it is usually done in front of an audience of friends and others, staking a claim to a valued identity, and expressing solidarity in a group or marking off social boundaries. "Peer influence" is often more a matter of the attraction of a particular social group for the teenager than it is a matter of pressure from anyone specifically to drink or become intoxicated. ²⁴

“It’s not pressure, it’s a choice.” You see other people doing it – older brothers and sisters or friends – they’re enjoying themselves, and you think ‘yeah, I want to be like that’.” Jack, 16

During the slow transition into adulthood, then, drinking at all and drinking to intoxication can symbolize freedom and autonomy, providing young people with a seemingly adult status. ^25,
26

Messages about not drinking "until you are old enough" have a double edge, reinforcing the status of drinking as a claim on adult status.

“When you’re 11 or 12 you have lots of curiosity. If you see your parents drinking, it’s something you want to try because you’ve seen them doing it.” Peter, 16

“Young people see an adult stressed at work come home and have a glass of wine, maybe a few, and they think that’s a good way to deal with it.” Tessa, 16

In the context of the social acceptance of adult drinking, young people may see messages that they should behave differently as hypocritical.²⁷

Why do young people use other substances?

There has been very little qualitative study of the processes involved in young people’s decisions to use substances. What information we have suggests substance misuse decision-making involves individual influences and social/contextual influences. ^{24, 28}

“When I use cannabis it helps me to think more clearly because I concentrate more” John 17

“I used speed when I was doing my Highers, it helped me to feel like I could get though the work, stay on top of things” Rachel 18

Individual influences often relate to the perceived function or effect of a particular drug.

“The first time I took it I thought it was great, I was totally giggling away, like I’d no worries or anything” Jamie, 14

Reports of drug use within youth culture also suggest that the experience of substances is often pleasurable rather than negative and damaging. ²⁹ They report using drugs to help them cope with negative moods caused by difficult living circumstances and relationships.

“It means I can shut everything out and I don’t have to think about things, and I can have fun with my mates instead of feeling down” Hannah 16

Other perceived functions include increasing confidence, suppressing appetite, decreasing inhibition, increasing energy.²⁴ These perceived function helps to explain the common association some drugs have with particular activities e.g. amphetamine, ecstasy and cocaine are commonly taken as dance drugs, and cannabis is more associated with relaxation.

Social /contextual influences include environmental factors, availability, finances and friends and peers.

“It’s like something to do and it’s there and it’s cheap and it’s like trying different things” Luke, 15

Stress and boredom associated with living environment can influence use, and in some areas, particularly more deprived areas, drug supply can thrive as an alternative economy. However drug use is certainly not restricted to areas of urban deprivation. Most young people are naturally curious and want to try different experiences. Research suggests that unless the gains from participating in other activities are similar to those perceived from using substances then they may not fulfil the same function. ²⁴

Peer influence is generally accepted as a major cause of adolescent drug behaviour as evidence suggests that young people are more likely to use drugs if their friends do. ^{30, 31}

In recent years ‘legal highs’ also known as new psychoactive substances (NPS) have increased in popularity. NPS are substances which produce similar effects to illegal drugs (such as cocaine, cannabis and ecstasy) but that are not controlled under the Misuse of Drugs Act 1971. NPS are now under control of the Psychoactive Substances Act 2016.

The term ‘legal high’ is believed to be misleading young people into believing these drugs are safe to use when in fact there are significant risks associated with their use. Mainly this is because they have widely different strengths and are frequently used in combination with alcohol or other drugs.³²In addition, these substances are increasingly found to contain an evolving mixture of ingredients, some of which are

illicit.

Glues, gases and solvents containing volatile substances are both legal and readily available. While it appears that the incidence of glue sniffing in Scotland has declined, there is evidence to suggest that this has been replaced by abuse of an array of alternative products, including aerosols and other household products, and, in particular, gas lighter refills. Nitrous oxide (laughing gas) is sold for many legitimate uses but is increasingly being used in a similar way to other volatile substances. The evidence suggests that the range of products that can be used, the availability of products, the low cost and ease of hiding products and the short term visible effects of use, make volatile substance abuse (VSA) easy to engage in and easy to hide. ³³

Drug availability and use are an issue within Highland and across social backgrounds.

What is a brief intervention?

A brief intervention can be described as:

a short, evidence-based, structured conversation about substances with an individual that seeks in a non-confrontational way to motivate and support them to think about and/or plan a change in their use in order to reduce their consumption and/or their risk of harm.

“What they don’t show is if it’s drunk sensibly it can be ok; they only show how bad it can be.” Jack, 17

Brief interventions involve more than just giving advice. They typically use specific techniques for helping people to change their behaviour. These techniques come from motivational interviewing approaches which promote a collaborative style of conversation that practitioners can use to help people explore and resolve their mixed feelings about behavioural change in a way that enhances their motivation and ability to make positive choices.^{34, 35}

Even short brief interventions (sometimes referred to in the literature as ‘brief advice’) have a structure and style that distinguishes them from simply advising a person to drink less.^34,
36

Motivational interviewing can be studied in detail as a technique in its own right, but this is not considered necessary for the provision of brief interventions.³⁵

What is not a brief intervention?

Merely giving a person a leaflet about use of alcohol and/or substances and telling them to read it, without any accompanying discussion, is not an evidence-based approach.³⁷
On the other hand, brief interventions are not the same as alcohol/drug counselling, specialist counselling training or experience is not required.³⁸
There is no strong evidence to suggest that multiple sessions or follow-up sessions to discuss consumption/ use are more effective than single sessions.³⁸

What is the goal of a brief intervention?

When asking a young person about their drinking/substance use in order to provide a brief intervention, the goals of the conversation are to:

give them an opportunity to discuss their drinking/substance use if they wish to do so
offer them feedback on how their drinking/substance use may affect them, particularly in relation to an issue or condition about which they are concerned
explore how they feel about cutting down their consumption/use or changing their drinking/substance use behaviour.
help them to make changes if they want to do so.^{39, 34}

“I don’t think it’s fair that you shouldn’t be able to drink at all, I think the advice should be about the way you drink. In France, people drink from a really young age but with their parents, with a meal at home. When they get older, they’re less likely to think: ‘alcohol, what a novelty’.” Frankie, 18

“Drinking is part of our culture. Changing rules won’t change society.” James, 17

Discussions should be sensitive to the young person’s age and their ability to understand what is involved, their emotional maturity, culture, faith and beliefs. The individual must decide on what changes, if any, are right for them. Any reduction in drinking/substance use will reduce associated risks,¹⁵ but if the young person is not interested in discussing their drinking/substance use, the practitioner should not continue the conversation.⁴⁰

Where there is a reason to believe that there is a significant risk of alcohol related harm, referral to more specialist services should be considered. (Brief interventions are described in more detail in Briefing paper 2: Promoting Behaviour Change).

How long does it take to complete a brief intervention?

Brief interventions can take as little as 5 to 10 minutes to complete, and even a single session can be effective.^{34, 36, 41}

In practice, the time that a brief intervention takes will depend on a variety of factors, including what the individual wants and how they feel about their drinking/substance use, the skills and confidence of the professional, the level of drinking involved, and the time available.³⁹

Who should be offered a brief intervention?

Brief interventions are suitable for any young person who is drinking alcohol at a level that exceeds what is advised for their age, or using other substances.

The NICE guidelines (2010) recommend that practitioners use their judgement to routinely assess the ability of children and young people to consent to alcohol-related interventions and treatment suggesting some may require parental or carer involvement.⁹ Making this assessment would be equally as important where the young person is using substances.

The advice on drinking limits for children and adolescents is as follows:

An alcohol-free childhood is the healthiest and best option. However, if children drink alcohol, it should not be until at least the age of 15 years. Then it should always be with the guidance of a parent or carer or “in a supervised environment”. If 15 to 17 year olds do consume alcohol, they should do so infrequently and certainly on no more than one day a week.

Young people aged 15 to 17 years should never exceed recommended adult limits when they drink and consumption should usually be below such levels.⁷

The adverse health and social effects of illicit drug use by young people can be very significant, although this varies greatly depending on the specific drug, the combination of drugs consumed, and the methods of intake, amount, and frequency of use. The advice to children and young people concerning use of other substances is not to risk using them.

Brief interventions are not suitable for young people who have developed dependence on alcohol/substances.

Alcohol/substance dependence is a term used to describe a range of symptoms and effects resulting from excessive alcohol/substance consumption, where drinking alcohol or using substances becomes a much higher priority for a particular individual than other activities that previously had a greater value. Other signs may include compulsive use or craving to take alcohol/substances, loss of control, and continued use despite harm.

It is important to raise the issue of alcohol/substance use with this high-risk group, but generally they will require more intensive support from specialist services. (Information about specialist support services is given at the end of Briefing paper 2).

Isn’t the delivery of brief interventions a specialist task?

Brief interventions are not complex to deliver. Furthermore, very few underage drinkers and adolescent substance users are, or ever will be, in contact with specialist addiction services. If most of the problems that are caused by alcohol/substances are to be prevented, it cannot be left to specialists alone to raise the issue. As both alcohol and other substances have such wide-ranging effects on so many different aspects of life, tackling related harm is everybody’s business, across all health and social care fields. This also makes it easier for practitioners to explain to young people why they are enquiring about their drinking/substance use.

More Alcohol Information

What is meant by terms like ‘hazardous’ and ‘harmful’ drinking?

Children and young people who drink more alcohol than the recommended limits are described as ‘hazardous drinkers’. It has been suggested however that the term ‘risky drinking’ would perhaps be better understood by this group.

The term ‘risky drinker’ can be used to describe a young person whose level of alcohol consumption or pattern of drinking will increase their risk of harm if their current drinking habits continue. It is recognised however that for some, very small amounts of alcohol or even any alcohol consumption at all could be hazardous in the short-term due to an increased likelihood of accidents, unsafe sex etc.

Harmful drinking is another term that is sometimes used to describe excessive drinking, and it has a specific medical definition. Harmful drinking is a pattern of drinking that causes damage to health (either physical or mental). In contrast with hazardous drinking, the diagnosis of harmful drinking requires that the drinking has already caused damage to the individual concerned. An example of this would be someone whose drinking has caused gastrointestinal problems, such as pancreatitis and chronic indigestion.

Alcohol and the Law

In Scotland the following laws apply to the purchase of alcohol for children and young people.

Age limits

People who are 18 years of age or older can buy alcohol in the same way as other adults. However, the license holder can refuse to allow anyone under 21 on the premises if they wish (they can refuse entrance to anyone they like so long as it's not on the grounds of race, gender or disability).
People over the age of 16 can buy beer, wine or cider with a meal as long as it's served with a meal and consumed in an area used solely for eating meals.
It is illegal for people under the age of 18 to buy or be sold alcohol in any other circumstances.
Children who are 14 or over are allowed on licensed premises but can't buy alcohol or have it bought for them.
Children under 14 are not allowed in the bar area of a licensed premises.
Children under 14 are allowed in the bar of licensed premises only where a Children's Certificate is displayed as long as they are accompanied by an adult for the purposes of consuming a meal supplied by the premises and away by 8pm.
It's illegal for any child under the age of 5 to be given alcohol.

From 2009, Scotland's new laws mean that buying alcohol for anyone under 18 is an offence punishable by a fine up to £5000 and/or a prison sentence of up to 3 months.

What exactly is a unit of alcohol?

The strength of alcoholic drinks is measured in terms of the percentage of alcohol by volume (% abv), which is the number of millilitres (ml) of pure alcohol in 100ml of a particular drink. Although the average strength of a range of alcoholic drinks has been increasing in recent years, a unit of alcohol in the UK has not changed size or measurement, and is still 10ml (8g) of pure alcohol (ethanol). This corresponds to approximately:

one 25ml measure of spirits (40% abv)
half a 175ml glass (i.e. half a standard glass in most pubs) of average-strength wine (12.5% abv)
half a pint of normal-strength beer or lager (4%).

Units =

volume (ml) x abv (%)

1000

It is generally more useful to think in terms of the approximate number of units that are contained in a variety of common drinks, rather than what constitutes one unit. For example:

a 175ml glass of wine (12.5% abv) contains 2.2 units of alcohol
a home measure of spirits typically contains almost 2.5 units of alcohol
a pint of normal strength beer, lager or cider (4% abv) contains 2.2 units of alcohol, whereas a pint of strong beer, lager or cider (6.5% abv) contains 3.6 units of alcohol
a 275ml bottle of alcopop (5% abv) contains 1.4 units of alcohol.

Drink Calculators, which can be used to calculate the number of units in most alcoholic drinks, can be obtained from NHS Board Health Promotion Departments. You can find out more about alcohol units and how to calculate them at www.infoscotland.com/alcohol.

Alcohol and drug information resources can be ordered locally from http://healthyhighlanders.co.uk/HPACK

Adapted from Health Scotland ABI course materials by Deirdre MacLean and Elspeth Lee (2015). Updated by Eve MacLeod 2017 and 2018.

References

World Health Organisation (2007). Expert Committee on Problems Related to Alcohol Consumption: WHO technical report no 944, 2007. World Health Organisation: Geneva.
Topic-specific sources and other key sources of cost-effectiveness evidence:

http://www.healthscotland.com/documents/23021.aspx

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Web links for references

21 http://www.highland.gov.uk/download/meetings/id/69587/item_19_highland_lifestyle_survey_2015

29 http://www.drugscope.org.uk/resources/faqs

33 http://www.drugmisuse.isdscotland.org/smrt/smrt.htm

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