The adverse effects of alcohol abuse are not confined . . . but affect the entire population At the beginning of the month, I attended a meeting at the Royal College of Physicians in London. Entitled "Alcohol - the Real Costs for Society and the NHS", 14 speakers, all associated in one way or another with the British National Health Service, dealt with the impact of heavy or binge-drinking on the cost and organisation of the hospital services.
The areas particularly affected are the accident and emergency services, inpatient and outpatient care, and the ambulance services. The information gleaned can be equally applied to the hospital and medical services in the Republic. The meeting dealt specifically with binge-drinking, whether episodic or continuous. It did not concern itself with alcohol dependency. Binge-drinking is the one which has the most effect on our general hospital services and which provides so many of the admissions to our emergency services, particularly at night and at weekends. Alcohol dependency is largely dealt with by the psychiatric service. It does not involve the emergency hospital services to the same extent.
Binge or recurring heavy drinking is increasing in Britain and Ireland, particularly among the young and among women. It puts a heavy burden on the hospital services which is difficult to quantify in terms of cost and the availability of limited healthcare.
According to a Royal College of Physicians working party, alcohol accounts for 12 per cent of hospital expenditure and 20 per cent of patients admitted with non-alcoholic illnesses have a history of heavy drinking. At least 50 per cent of admissions to A&E in Britain are related to drinking; emergency physicians in Ireland have the same experience.
Many of these patients are admitted for observation or treatment, not only because of injury but also because of the adverse effects of excess alcohol on the liver, heart, brain and other organs. Binge-drinking adds greatly to the cost of our ambulance services because of the large numbers of night/weekend admissions with acute alcohol problems. The adverse effects of binge-drinking put a serious burden on the hospital services, contribute to the waiting lists for elective medical and surgical treatments and occupy hospital staff in a disproportionate amount of work. It is also clear that hospital staff are ill-equipped to deal with the burden of drunk patients.
Acute alcohol-related illnesses in the hospital setting get little attention in undergraduate and postgraduate curriculums. Junior doctors are little concerned with the problem if one is to consider the infrequent reference to alcohol in patient notes. They accept it as an inevitable fact of life in affluent, modern Ireland. One study of hospital clinical notes reported that in only 37 per cent of adult patients was there an inquiry about alcohol habits.
Senior doctors were described as having no interest in counselling or other meaningful behavioural modalities aimed at the long-term control of heavy drinking, and in some cases they can be hostile to such programmes. Nor do psychiatrists play an active role in dealing with patients admitted to general hospitals with acute alcoholic problems.
Hospital staff tend to be alienated by drunks because of their anti-social and self-destructive behaviour. The inevitable stress engendered, particularly among A&E nurses, leads to serious loss of staff and difficulties of recruitment. While family medical care at the general practice level was not on the meeting's agenda, it also emerged that family doctors in general have little inclination and less time to counsel their binge-drinking patients. They rarely ask about their patients' drinking habits.
What did emerge was the efficacy of employing a dedicated alcohol management nurse trained to counsel binge-drinkers admitted to A&E departments.
Several British hospitals are reporting the benefits derived from the employment of a specially trained nurse. Using a simple questionnaire administered before the patient is discharged from A&E or hospital, and offering a follow-up counselling service, about 50 per cent of patients returned for further counselling by the nurse and clearly many of those were anxious to receive help. In follow-up studies, it is evident that many of these respondents do reduce their drinking.
The hospital scene in Ireland, as in many other Western countries, provides one of the more frustrating aspects of our healthcare system. The reasons are no doubt complex and may seem insoluble in the light of exponentially increasing cost, of inappropriate medical training, increasing public expectations and the litigious trends engendered by an acquisitive society.
Binge-drinking and other inappropriate heavy drinking and their effects on the health services have to be seen against the wider background of the effects of alcohol abuse on society. These include accidents, drownings, violence, crime, poverty, poor health and mental illness, family disintegration, unemployment, intimidation and a reluctance in certain areas to walk the streets.
The adverse effects of alcohol abuse are not confined to drinkers and their families but affect the entire population. I believe we are too permissive about alcohol, even when it is taken to excess.
All are culpable in this attitude - the Government and local authorities, the professions, industry and the commercial world, sporting organisations and the media. These institutions, however, are simply reflecting the attitudes of the public in general.
We need a more mature approach to a habit which should be a boon and a blessing rather than a destructive element in our land. We need an effective public education programme, aimed in particular at older children and young adults, not demonising alcohol but underlining its benefits in a mature and affluent society.
The Department of Health's current Responsible Serving of Alcohol initiative and its Alcohol Awareness Campaign are welcome but much more will need to be done at a cultural level to change the country's attitude to alcohol.
While an unnecessarily restrictive approach by Government is unlikely to succeed, there is little doubt that certain restrictions are desirable and may be effective.
Drinking in public places such as the street, parks and public holiday sites should be forbidden. Better control of advertising and inspection of night clubs must be considered. Whatever is done, the healthcare professions, by providing an appropriate counselling service for all those who finish up in the A&E or hospital wards and encouraging behavioural change, could do a lot more to help the many people who drift into the heavy drinking culture.
Risteard Mulcahy is professor of preventive cardiology (emeritus), Charlemont Clinic, Dublin.