Dying for a drink

As the annual cost to the NHS of alcohol abuse soars to £3.5billion, what role can doctors play in tackling this worrying trend?

THE number of people being admitted to hospital each year in England for alcohol-related problems has more than doubled in the last 10 years, and now tops one million.

According to official figures from the NHS Information Centre, there were 1,057,000 alcohol-related admissions recorded in England in 2009-2010 compared to 945,500 the previous year. And that’s excluding A&E treatment. In 2002-2003 the figure stood at 510,800. Of the 1,057,000 hospital admissions, one in four was wholly attributable to alcohol while the remainder was partly attributable to drinking. The report also showed alcohol dependency cost the NHS £2.4million in prescription items in 2010, up 1.4 per cent on the previous year.

Meanwhile, a 2012 Department of Health (DoH) report, submitted to a Commons health select committee inquiry, put the annual cost to the NHS of alcohol misuse at £3.5billion. That’s up 30 per cent in just three years.

Combine these statistics with the perpetual onslaught of media reports of drink-fuelled violent crime and anti-social behaviour and alcohol quickly begins to look like public enemy number one.

And while alcohol abuse may be seen by some as a problem for the police and criminal justice system to solve, the impact on the NHS cannot be ignored. The 2012 DoH report warns more than 60 diseases and conditions, including heart disease, stroke, liver disease and cancer, can be directly linked to alcohol.

Preventive role

So is it time doctors played a more active role in the prevention of alcohol abuse, rather than focusing on repairing the damage it causes?

Senior lecturer and consultant oral surgeon Dr Christine Goodall believes so. She is based at the Glasgow University Dental School and has witnessed first-hand the horrifying consequences of violent crime, much of which is alcohol-related.

She is also one of the founders of the charity Medics Against Violence (MAV) in which medical professionals visit schools across Scotland to speak to pupils about the consequences of violence. To date, the charity has spoken to more than 10,000 young people with plans to further expand the programme.

Dr Goodall says: “I have worked in the maxillo-facial field for a number of years and the majority of facial trauma coming in – such as lacerations and fractured cheek bones – is in some way linked to alcohol use. Most facial trauma is the result of interpersonal violence amongst people – often young people – drinking to excess.”

The surgeon has often seen the same patients return with facial trauma time and again, a trend which she says can be “soul destroying”. It was this trend that prompted her and a group of fellow maxillo-facial surgeons to set up MAV in 2008 in a bid to influence attitudes to violence among young people.

She believes doctors – and particularly junior doctors – can play a key preventive role in the wider campaign against violence.

She says: “I think it is important for doctors not just to see their role as one that focuses solely on repairing the damage caused by violence. It’s about making a leap from thinking ‘that’s not my job’ to believing this is something in which they can make a positive change. It is important not to be put off by the scale of the task, but to do what you can.

“Young doctors are key to this as they will have the opportunity to adopt this approach early in their careers. One thing is for sure, if things don’t change then the medical profession will be mopping up the fall-out from alcohol abuse for many years to come.”

Dr Goodall believes even small changes can help to tackle the problem. One example is the practice of nurse-delivered brief interventions for problem drinkers who are suffering facial trauma. Dr Goodall led a study in 2007 that found the practice of nurses offering advice and support to this group of patients helped many reduce their drinking, even after 12 months.

Dr Goodall says: “There’s a tendency within the medical profession not to think so much about prevention of violence or alcohol abuse in the way there is with smoking. But there would be huge benefits to both the health service and to people’s health if more doctors engaged with this approach.

“It is now standard treatment in the maxillo-facial unit at the Southern General for nurse intervention amongst trauma patients who are problem drinkers. It doesn’t take up a lot of time and it is making a difference.”

Political plans

While medical professionals can play a part in tackling the rising problem of alcohol abuse, their efforts need support from official bodies such as PCTs, Trusts and health boards as well as government.

In their 2011 report Making alcohol a health priority – Opportunities to reduce alcohol harms and rising costs the charity Alcohol Concern found services for alcohol misuse in England “have remained shamefully under-invested in” with specialist treatment only available for fewer than six per cent of dependent drinkers. It calls on GP consortia to engage with the issue of alcohol misuse and for the government to “double our current investment, leading to improved public health savings of £1.7billion a year for the NHS.” The charity also calls for comprehensive strategies to be drawn up at both local and national levels to tackle the problem.

Political moves are already underway in some parts of the UK and have been widely supported by the medical profession. Under the Alcohol Act 2011, the Scottish Government banned discount deals on alcohol sold in shops and tightened restrictions on alcohol advertising. It now plans to reduce the drink driving limit (from 80mg per 100ml of blood to 50mg) and set a minimum alcohol price of 50p per unit.

A study from Sheffield University suggests a 50p unit price would cut drinking by 5.5 per cent and save 60 lives in the first year, rising to 300 per year after 10 years. The study suggests there would be 1,600 fewer hospital admissions in the first year, rising to 6,500 fewer admissions after 10 years.

A number of organisations have backed the moves including Alcohol Concern, drinks producer Tennent’s, Scotland’s Chief Medical Officer Dr Harry Burns and BMA Scotland.

BMA Scotland chairman Dr Brian Keighley says: “A minimum price, as part of a wider strategy, could end Scotland’s heavy drinking culture” and “will also reduce the toll of alcohol on the health service.”

There are plans to introduce a similar raft of measures in England and Wales, including a 40p minimum alcohol price, under the government’s new Alcohol Strategy. An inquiry into the proposals is being carried out by the Commons Health Committee.

Joanne Curran is an associate editor of FYi