Date Published: 8 September 2006
Calls for all medical staff to have greater knowledge of alcohol abuse
Large amounts of money and resources would be saved if all frontline NHS staff had basic knowledge about the social and physical effects of alcohol misuse, according to doctors in this week's BMJ.
Their editorial follows the government's recent announcement that £3.2m is to be made available for new initiatives for people who may be damaging themselves with alcohol.
Robin Touquet, of Imperial College London and St Marys Hospital, and retired physician Alex Paton argue that some of this funding should be used to ensure that all frontline staff understand and can detect alcohol misuse. This training should be especially directed at the new Foundation Year doctors, who spend two years in an NHS hospital after graduation as part of their training. The researchers also call for every acute hospital trust to have their own Alcohol Health Worker, currently found in only 21 acute hospitals in England.
Nearly a third of overall attendances at hospital emergency departments are alcohol related, and after midnight this figure can be more than two thirds. The authors believe that funding should be used to support clinical settings such as emergency departments, where alcohol misuse is common and where detection and intervention are likely to be most effective.
The suggested measures would mean that problems could be tackled early on, say the authors, preventing the development of alcohol dependence and saving large amounts of money.
Professor Touquet, from Imperial's Accident and Emergency group, said:
" Because alcohol is a legal social lubricant, enjoyed by many - but still a drug - it is not given the appropriate attention, or respect.
_ Every available effort should be made to make best use of 'teachable moments', when patients are encouraged to develop insight into their alcohol misuse and its resulting effects, such as attendance at A&E. The availability of Alcohol Health Workers transforms staff attitudes, and provides the expertise to encourage patients to contemplate change, the earlier on in their drinking career the better. It is simple and practical; what is more, it saves more than it costs. All NHS doctors have a duty of care to reduce hospital re-attendance."
Other measures suggested by the authors include closer liaison between general practitioners and local voluntary alcohol agencies, wider availability of alcohol workers and alcohol clinics in general practices. They also propose that all general hospitals should have a senior consultant with an interest in alcohol misuse.
A previous Lancet paper in 2004 by Professor Touquet, an Emergency Medicine Consultant, and colleagues, showed that by offering A&E patients who had been drinking excessively the chance to see an Alcohol Health Worker, it was possible to reduce excessive drinking and limit subsequent visits to hospital.
After six months, those who were referred to an Alcohol Health Worker were consuming on average 60 units of alcohol a week, while those who were not referred were drinking 83 units. At the same time, those referred to the health worker had an average of 0.5 fewer visits to A&E.
About £217m per year is currently spent on specialist alcohol treatment, compared with the £20bn estimated cost of alcohol misuse. Every year, there are about 35,000 deaths in the UK related to alcohol. In 2004 in England 38% of men and 16% of women aged 16-64 had an alcohol-use disorder, equivalent to around 8.2 million people.
Source: Imperial College, London (England, UK).