We often think of alcohol misuse in terms of dependence and the conditions associated with heavy drinking like liver disease and pancreatitis. But, as last year’s Chief Medical Officers’ new guidance indicated, lower levels of alcohol misuse can contribute to a wide range of conditions not so readily associated with alcohol. Is it therefore worth considering how alcohol could be affecting the health of a wider range of patients and not just heavy drinkers?
The guidance indicates that regular consumption of more than 14 units of alcohol a week significantly raises the risk of ill health for adults. In fact, the risk of some cancers, including breast cancer, starts to increase with regular consumption of any alcohol.
Obviously, most people don’t knowingly want to take risks with their long-term health. The majority of patients who regularly drink over 14 units are probably unaware of the level of risk from their alcohol consumption. But, there are quick, effective screening tools available to health professionals to assess a patients risk from alcohol use and strong evidence that spending less than five minutes making people aware of that risk can persuade them to drink less.
Identifying those at risk and alerting them to the risk, known as alcohol identification and brief advice (IBA), has been researched extensively over the last 35 years. The overwhelming conclusion is that the practice can reduce weekly drinking across the patient cohort by up to 34% (between 3 to 9 units per week). This will reduce relative risk of alcohol-related conditions by c14%, and absolute risk of lifetime alcohol-related death by c20%.”. IBA can take less than 5 minutes and surveys have found that patients expect and are accepting of health practitioners asking about their alcohol use. NICE guidance recommends that all health professionals carry out IBA as an integral part of routine practice.
NICE guidance also recommends alcohol screening and advice for hypertensive patients – 35% of hypertension cases among men and 15% among women are alcohol-related[i]. Reducing alcohol consumption reduces the blood pressure of hypertensive people and alcohol-induced hypertension resolves within two to four weeks of abstinence (or substantial reduction)[ii].
IBA might be done at key opportunities with all patients, or targeted at particular at-risk groups. There are numerous opportunities to address alcohol consumption, such as when patients register with a GP or when reviewing medication. The NHS Health Check also includes an alcohol risk assessment and advice to those at risk and, in 2017-19, a CQUIN scheme will incentivise alcohol IBA and very brief advice on smoking for all inpatients in secondary care.
Health Education England e-Learning for Healthcare (HEE e-LfH) has therefore worked with Public Health England to produce e-learning sessions to support delivery of IBA. Courses take less than an hour to complete and give health staff understanding of the tools and techniques for delivering effective IBA.
For more information about e-LfH visit www.e-lfh.org.uk.
Professor Sir Ian Gilmore MD, DL, FRCP
Chairman, Alcohol Health Alliance UK