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Having the conversation about alcohol

Posted by: , Posted on: - Categories: Health and Wellbeing, Reducing the burden of disease

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.

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  1. Comment by Yes, I have a name posted on

    "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."

    Or, alternatively, they are _perfectly_ well aware of the real but low risks they are running, and consider these well worth while for the pleasure that alcohol gives them.

    You have said yourself that this is not like tobacco, in that these drinkers are not addicted and, unlike smokers, they do not wish to give up. Be very, very careful where you go with this.

  2. Comment by Shiju Joy posted on

    Like highlighted in this article, the healthcare professions should provide some educational materials regarding the consequences of alcohol consumption. It is up to the patients to accept it or not. They do have the right to choose the lifestyle they want. Having said this, remember one does not become a heavy drinker before being a moderate drinker. Things can change quickly over time.

  3. Comment by Bren posted on

    Hello Kevin,

    A really informative and thoughtful blog. I just wondered if the "making Every Contact Count" can also be a way of raising the issue. I do think there is an element of not judging and at what time and the circumstances the discussion and offer of support is made. I also think, as with so many areas it is about the discussion and looing at what integrated care is made available to meet the person's needs.

    Thanks and all good wishes,


  4. Comment by ash54 posted on

    Grieving Sister

    This is very difficult and I don't know where to start. My brother was an alcoholic and people always judge and have their cruel opinions like it's their own fault etc etc. People are not aware that alcoholism is a disease not an addiction
     Many will not understand or try to understand and many who judge you has a lowlife nobody waste of space and expect trouble from an alcoholic which I experienced and witness for 3 years from the least expected source not everyday people but trained medical professionals and support workers. Too me he was my loving older brother and very loved by our mother. My brother was a someone human being who also felt pain but by the TRAINED medical professionals seen has an alcoholic waste of time and expected trouble. Didn't bother looking into his medical history and his illnesses like high BP diabetes epilepsy liver cirrosis heart failure. Took my brother on the 28th to A/E he had high temperature and vomiting
    Doctor at A/E approached the cubicle and said do you know this is his 69th visit I was shocked by what he had said and that he wasn't concerned that my brothers blood pressure was 256. Doctor said me that's normal for him
    My brothers eyes all of a sudden went yellow then the colour of mustard told doctor he said no he isn't jaundice and my concern on how high his blood pressure was and that it could cause an heart attack. I see the change and how he was suffering I was scared and knew this ain't good. Because I read up a lot on alcoholism, the signs, detoriation of health. It was like me telling them what is wrong but because they were doctors they knew better BULLSHITTT. My brother was sent home because blood test come back normal and was told same has last time straight away I knew they hadn't and he just wanted my brother gone. 31st rushed into hospital via 999 call my brother had a massive heart attack and was told 24hrs are critical and don't look good because oxygen and blood levels very low. They put him in HDU not INTENSIVE CARE he suffered and was in so much pain I saw him suffering and was told he was given the highest dose of pain relief BULLSHITTT  he died at 0640hrs 01 he suffered and I saw it couldn't help him and this is the last memory of my brother I have him fighting for his life and the professional medics didn't care. My mother became very ill after my brother passed away 9 months later my mother passed away with terminal lung cancer that took her in 3 months of diagnose. I have struggled and still an because I was close to them both I suffer with severe depression and my dose of antidepressants is high. I am also left traumatised. I am taking this further because these hospitals gps support workers think they are untouchable because they are trained qualified professionals i know more than them. Loved to be questioned about alcholism and a doctor also. I know that my answers will be deep and from experiencing the only person I know loved me because I felt it my brother father figure.??

    • Replies to ash54>

      Comment by Kevin Fenton posted on

      I am so very sorry to hear of your loss. This underscores why we all need to do more to tackle the harms of alcohol which can devastate the lives of people, families and communities. Thank you for sharing your story with us.