According to a report from Leicester University, GPs and other health professions find it difficult advising patients on how to address their harmful drinking habits. Why is this, an...

According to a report from Leicester University, GPs and other health professions find it difficult
advising patients on how to address their harmful drinking habits. Why
is this, and what could be done to help patients who want to, or need
to, make a positive change?

The report correctly identifies the difficulties many medical professionals find in correctly identifying and treating alcohol dependence. This is not as surprising as it sounds. For example, an A&E department on a Saturday night sees as many as seven out of ten patients attending partly because they have consumed too much alcohol, though it is not usually the alcohol itself that they are there to be treated for. Often it is these same people who find themselves back at A&E time and time again, at a cost of £0.5 billion annually to the NHS. Additionally, around a fifth of people admitted to hospital for non-alcohol related conditions have been drinking at levels which may affect their recovery.
But with a little assistance from trained alcohol treatment professionals, the ability to identify and treat these individuals can be vastly improved- not just for the cuts and bruises which may have brought them into hospital in the first place, but for the alcohol dependence which is the causal problem that all too often lies beneath the repeat visits to A&E.
Turning Point is one of several organisations that trains hospital staff about alcohol dependence, brief interventions and referring to other services, thereby helping to reach patients for whom alcohol may be an underlying issue. In some places Turning Point is training A&E nurses to make brief interventions at the point of treatment – while removing stitches, for instance. This is a particularly effective way to reach people who may not otherwise approach an alcohol service.

Yes I think that's right, and it has to be acknowledged that demand, especially at critical periods like weekends and large public events do create major stresses on the ability of the system to cope. Of course the best time to start a BI is when the person being treated is perhaps more open to contemplation, which is more likely to be when the crisis is over, and certainly when the effects of their drinking have worn off.
But the issue extends beyond treatment, does it not, especially in a Public Health context? I would argue that much more could be possibly achieved by taking other opportunities to discuss a person's alcohol consumption, for example during attendance at a regular health check, and this is where the debate could also lie. This report also raises an important issue which I have to say is reinforced in my own experience not just with health professionals, but many others, that one of the barriers is the personal relationship the GP, nurse, teacher has with alcohol.
What can become a barrier to intervention is the experience that person has had or has with alcohol and how that can interfere with an effective approach. It seems to me that one of the challenges facing Public Health is to break down these barriers by improving alcohol awareness in the workforce, enabling people to address these issues positively and to free them up to be able to take the opportunities when they arise to discuss alcohol use with their patients.

The points about why it might be hard for GP’s to address alcohol , is that it is a complex and long standing issue but worthy of some thought because of very fact. Our attitude to alcohol is mixed and the government as one of the main benefactors of alcohol consumption( and thought them of course ourselves) derive a massive benefit in tax returns. The expectation is that we should be able to manage our drinking but it is a psychoactive drug and probably once of the most dangerous and lethal to individuals and family life. It is only because it is part of our culture that we can allow this contradiction. But this is not talked about but leaves professionals like GP’s in a very confused and complex situation especially so since they were at one time one of the high drinking professions. I don’t know if this is still the case. However our own drinking usually means we tend resist examining our own use and therefore being hampered in helping others to do this. Another factor of course is that very little time is given even to a medical understanding of alcohol use in a doctor’s training, but in fact treatment needs a much more complex approach than this.
However I believe the most over riding factor is what was identified by the Maudsley research in the 70’s which identified that in order for professionals to be able to the work with the complex, contradictory and self destructive behaviour it is essential that we are clear what our role is in relation to the drinker, that this is supported within structures we work and we have psychological support to allow us to bear the impact of such chaotic and destructive behaviour. I think that in the current culture of targets and time limited appointments it is highly unlikely that GP’s are going to be able to fulfil this expectation, which requires a responsibility to be taken at a social level . I think it is helpful to recognise that alcohol use in not a problem but the fact that we use it to address our problems is .

Seems an unreasonable expectation for GPs and healthcare experts to address someone's harmful drinking especially given the limitations of time. Seems far more rational to tackle a personal, social and cultural issue such as drinking in a personal, social and cultural way. The only person who can know how to 'solve' an individual problem is the person themselves. A GP has no way of knowing why a person drinks nor the best solution. Whilst a GP can bring a certain knowledge to the table, this has to be combined with the knowledge of the person and indeed a wider knowledge of their social and cultural situation ( family, friends, housing, employment, etc). This sounds like co-production to me. A serious attempt to work together to understand drug, set and setting. A serious attempt to recognise the strengths and assets of the 'patient', their own knowledge of the path forward and their own right to choose. If people in recovery/ recovering from addiction are not at the centre of their own journey then they are not only disempowered but the responsibility of recovery then moves to an 'expert' and this seems to be an impossible burden.
In my opinion the harmful alcohol user is best supported by a wide community that understands their situation and the journey to recovery. Expert interventions may be needed to support a journey but the path always has to be decided upon and walked by the person themselves. There are no one size fits all answers just a massive diversity of recovery pathways. A GP or healthcare expert needs to signpost, handhold, listen, share, talk and guide.

This is an issue which has also emerged with A&E alcohol liaison nurses. Part of their role is to train frontline staff to screen all patients re their alcohol use and they often meet with a lot if resistance from staff who feel a)This is intrusive
b) They are already too busy
c)This is the business of specialists only
d) They would not like to be asked about their drinking if they went to hospital with something unrelated to alcohol.

Alcohol misuse is one of the major challenges facing us today, especially in the context of public health initiatives. Most people are familiar with the statistics about alcohol misuse and its contribution so I'll not repeat them here, but one of the most striking aspect of this issue is that the harm is avoidable and preventable. So, taking opportunities to make people aware of how much and how frequently they have a drink is one important step towards reducing harm. Dr Jonathon Shepherd's work in Cardiff and some of what's happening in Scotland around Brief Interventions seem to demonstrate the immediate value in encouraging people to think about their drinking. My dentist routinely asks me about how much I drink and I know has information which can be given to me if I wished it - the whole process takes less than a minute and is incorporated into my routine examination.
Most people are not aware of how much they drink at home, and how to measure a unit of alcohol, raising people's awareness about how much they drink and the potential health and social harm they risk doesn't take a lot of time. Should people want to explore questions they might have further there are easily available tools for them to do so, MyDrinkaware being one such tool. Public Health, as I understand it, is about prevention and raising awareness of how people can take positive steps to improve their health and wellbeing. Is this not everyone's role?