Back in the 1980s, the Royal College of Psychiatrists published ‘Alcohol: Our Favourite Drug’. Not much has changed over the years. Eighty-five per cent of adults drink alcohol and luckily, most of us drink in a ‘low-risk’ way. But well over a fifth of the population regularly drink more than what may be healthy for them and they are putting their future health at risk – many may not realise this.
Today, we drink twice as much as our parents and grandparents did in the 1950s and ’60s. This is not surprising giving the increase in the availability of alcohol. Pub opening hours have been relaxed and more of us are drinking at home, picking up our bottles of wine, beer and spirits along with the weekly shop. Supermarkets have replaced pubs as the biggest outlet for alcohol.
Price has also played a part – in real terms, alcohol is cheaper today than it has ever been when compared to our earnings and how much money we have for luxury items. Alcohol consumption has levelled off in the past few years, mainly due to the economic downturn, but the level is still fairly high. Where many other European countries are reducing their consumption over the past 40 years, here in the UK ours has been increasing.
Most people are unaware that they are drinking over the lower risk limits (the guidelines are that women should not regularly drink more than 2 to 3 units a day and men should not regularly drink more than 3 to 4 units a day) and most are unconcerned about their use of alcohol. The overwhelming majority of these people are not alcoholics: they do not have a serious problem with alcohol dependence, they are just drinking too much too often. While many are aware of the link between alcohol and liver problems, there is far less awareness of the links to cancers, high blood pressure and over 60 other health problems.
The result of all this is that alcohol-related harm continues to climb. Alcohol is now the third leading, but avoidable, contributor to ill health after smoking and high blood pressure. Alcohol plays a role in over a million admissions to hospital and is costing the NHS over £3.5bn every year.
The causes of harm from alcohol are complex but preventable. A multi-layered public health response is needed to tackle this complexity: evidence-based policy and action at population level, targeted both at those most at risk and those who are already experiencing problems. While some of this is the responsibility of national government, there is much that can be done at a local level.
This week is Alcohol Awareness Week, and this year the theme is ‘conversations about alcohol’. The aim is to get people thinking about alcohol: how it affects us as individuals, families, communities and society. It encourages people to have the right conversations about alcohol to support changes in our consumption and our relationship with alcohol in the UK.
So, what can health professionals do about this? They can start by having a conversation with their patients about alcohol. This seems obvious and there is 30 years of research showing the value of giving patients advice about alcohol and the impact that can have on their drinking and health. However, this conversation rarely happens.
Alcohol appears to be the new tobacco in this respect. A generation ago, healthcare professional had trouble raising the issue of cigarette smoking with their patients. They didn't like commenting on someone’s lifestyle and, often being smokers themselves, felt a bit hypocritical raising the issue. Today, healthcare workers have no problem raising the issue of smoking with their patients. They are bolstered by research demonstrating that most smokers want to quit, they just don’t know how and are addicted to nicotine.
Today, it is alcohol that healthcare professionals are reluctant to raise with patients. They fear the bad reaction they think some patients might display and they do not wish to damage the therapeutic relationship they have built with the patient.
There are also lots of practical reasons for not discussing alcohol with patients. Healthcare professionals are very busy people and time is always limited. Their priority is to address the problem the patient has approached them about. Some feel they don’t know enough about the issue to raise it with their patients and, unless someone has a very obvious alcohol problem, they often fail to make the connection between the patient’s condition and the contribution alcohol could be making to it.
We need to overcome this situation. Healthcare professionals have a powerful voice. People listen to them. They can make a real difference in helping patients manage current conditions and avoid future health problems. Giving advice on lifestyle issues is a quick win that can save the patient future health problems and save the NHS unnecessary expense.
But how do you begin this conversation? And with whom? Only a minority of patients will be drinking at risky levels – how do you identify them? There are a range of reliable screening tools to help identify patients who are drinking at risky levels. These take just one to two minutes to use. There isevidence that screening is a powerful tool in itself – just using an objective measure and informing the patient of the results can trigger change.
The advice about alcohol that follows screening does not have to be extensive. Just giving people a bit of information about how alcohol could be linked to their condition and how it might contribute to future health problems is a great start. Encouraging people to change and providing them with a set of things they could try helps them see that change is possible. All of this can be supported by information that patients can take away with them to read later. Evidence shows that for every eight people drinking at risky levels who receive advice, one will change their consumption to lower-risk levels. This compares very favourably with smoking cessation interventions.
So, raising the issue of alcohol is a job for all of us. For example, alongside healthcare professionals having the conversation with their patients, employers should be doing so with their staff. We do not have to be experts, we just need to be courageous and take the opportunities we have to help people help themselves.