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Why raise the issue of alcohol?
- Based upon alcohol consumption on their heaviest drinking day in the previous week, the 2008 Scottish Health Survey suggests that just under half of men and over a third of women exceed the daily drinking limits on their heaviest drinking day, and that around a quarter of men and one-fifth of women binge drink.
- Alcohol-related deaths have almost doubled in the last decade. Mortality rates in Scotland are now twice that of the rest of the UK, with the rate among Scottish women now higher than that of English men.
- Drinking among the female population in particular has increased, although it is still lower than the level of drinking among males.
- People are being diagnosed at a younger age with alcohol-related diseases such as liver cirrhosis.
- Harmful consequences of drinking are not confined to the heaviest, dependent drinkers. The wider population of people drinking at hazardous and harmful levels also experience harm from their alcohol consumption, and it is this group for whom brief interventions are most effective.
- In the last decade, alcohol-related attendances at Scottish hospitals have increased by almost 50%.
- Alcohol is a contributory factor in a wide range of physical and mental health problems, including many cancers, high blood pressure, Stroke, liver or Heart Disease, gastric problems, accidents, depression, and anxiety among numerous others.
- Excessive alcohol consumption can also affect non-drinkers in many different ways. This includes the impact of parental drinking on children, the contribution of alcohol consumption to violent behaviour, drink driving, fires and accidents, and the effect of drinking on relationships, families and employment.
New Alcohol Guidelines
In January 2016 the UK Chief Medical Officers released new guidance on alcohol consumption for both men and women. The guidelines for both men and women state:-
- You are safest not to drink regularly more than 14 units per week, to keep health risks from drinking alcohol to a low level
- If you do drink as much as 14 units over week, it is best to spread this evenly over 3 days or more.
- If you have one or two heavy drinking sessions a week, you increase your risks of death from long term illnesses and from accidents and injuries.
- The risk of developing a range of illnesses (including, for example, cancers of the mouth, throat and breast) increases with any amount you drink on a regular basis.
- If you wish to cut down the amount you’re drinking, a good way to help achieve this is to have several drink-free days each week.
Why have the guidelines changed?
- Stronger evidence now exists that the risk of a range of cancers (including mouth, throat, oesophageal and in particular breast) increase directly in line with any amount of alcohol consumption.
Why is the guidance for men now the same as for women?
- The guideline for weekly alcohol consumption is designed to reduce both the risk of deaths from regular drinking and the chronic, long term health harms that alcohol causes. Women’s long term health can be affected more by alcohol but on average men are at much greater risk from the more immediate harms such as accidents and injuries.
How to raise the issue of alcohol?
- Wording that might be used to introduce the topic of alcohol:
- ‘It’s surprising how even small amounts of alcohol can affect [the person’s condition/situation]. Do you take a drink now and again?’
- After establishing if a patient drinks alcohol it is important to accurately assess what a patient drinks in a week in order to have an informed discussion about drinking.
- It is recommended that you ask the patient what they usually drink in a week, and in what quantities. This will help you to establish how many units of alcohol they typically consume in a week and how many units they consumed on their heaviest drinking day in the last week.
- Click here for examples of units of alcohol in some typical drinks.
- In addition in order to identify whether the patient may benefit from a brief intervention it is important to identify if the patient drinking pattern is harmful or hazardous.
- The Fast Alcohol Screening Test (FAST) has a high level of accuracy in detecting hazardous and harmful drinkers across a range of settings, and contains only four questions. Moreover, many people who are screened with the FAST tool only need to be asked one question in order to obtain a positive result.
- The FAST tool is not designed to detect alcohol dependence, but if a patient shows any signs of dependence, please consult you GP.
- If the patient has made any changes in the previous 12 months, explore how the patient is getting on and how they could benefit from support.
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