Nursing Council on Alcohol - the need for nursing action

Alcohol is the most commonly abused substance in the world (Lieber, 1995). It is the mind-altering substance that we would all like to distance from other mind-altering drugs that are currently illegal in the UK and elsewhere. Once ingested, it begins to induce feelings of well-being and act as an excellent social lubricant, that is, provided one is feeling like socialising. As a drug, mixed with human emotion, it can also increase feelings of despair to the point of enhancing our individual motivation towards attempting or successfully committing suicide.

When consumed in large amounts we can behave in ways that are unacceptable to the society in which we live and yet, who often appear accepting of the excuse that we cannot recall our poor behaviour because of its consumption. It is often favourable to 'get blitzed' (very drunk) to the point of physical illness as a means of having 'a good night out.' How one can feel so nauseatingly ill and yet link this to a good time is still a subject for debate!

Alcohol use at a reasonable level, under the appropriate circumstances is beneficial, both socially and, there is some indication, physically. The difficulty arises for the individual when alcohol is used inappropriately. It is unrealistic to expect that, despite the best efforts of those in consecutive governments, and research, prevention and treatment fields working with the individual, that one can create a general approach to the problems linked to alcohol use, and the associated consequences, in expectation that there will never be any more alcohol-induced problems.

Perhaps the best one can do is to keep revising the approach, as new information becomes available. Research should lead the way. However, there is no use in funding research if the findings are not transferred in to practice. Not just by the nurse working in the alcohol speciality but all nurses who hold a responsibility for the care of individual within the hospital, the community, and within society as a whole.

One certain thing is that we will never know all there is to know about alcohol related problems. Alcohol will always offer up surprises. What interventions nurses offer depends on their knowledge, and ability to use other people's knowledge. Nurses have a responsibility to offer the best that is known, to the best of their ability, at that time.

Knowledge and understanding of alcohol use is constantly changing. The challenge is to remain open to the information that will help the nurse provide:
*  Appropriate therapeutic intervention,
*  At the appropriate level
*  At the appropriate time
*  At the appropriate cost
*  With the appropriate understanding of the individual presenting with the problem.

Some Facts

In the United Kingdom, nearly two fifths of men, and around one fifth of women regularly consume alcohol at levels that exceed the daily and weekly-recommended limit, these numbers continue to rise (Department of Health, 2000). From a global perspective, 3.5% of all disability adjusted life years are attributable to excessive alcohol consumption.

The health, social, economic and fiscal costs of harmful and hazardous drinking represent a major source of concern. Although precise figures are difficult to discern, it is estimated that the cost to industry of alcohol abuse is approximately £14m per annum. Because of the widespread consequences of alcohol problems, the impact on nurses working in both community and hospital settings is considerable.

Nurses are ideally placed to provide information and advice that has been indicated to be effective in reducing harmful alcohol use. A number of randomised control trials have show that, in comparison with controls, hazardous drinkers receiving 5-10 minutes of brief structured advice plus a self-help booklet from a primary health care worker will reduce alcohol consumption by around 25% (Freemantle et al, 1993).

Additionally to the emotional, social and financial hardship experienced by the individual and the family, harmful alcohol use can have a marked impact on each of the body's systems. Consequently, the individual harmfully using alcohol is frequently exposed to the general medical, surgical, accident and emergency and all specialty clinics and wards of the hospital setting, in addition to mental health and specialist alcohol services.

This is not to exclude the impact that harmful alcohol use can have on members of the family, significant other or innocent victims of drunken outbursts or drunken driving that also impact on community and hospital services.

Evidence suggests that a large number individuals attending hospitals experience alcohol-related problems, this is independent of the presenting condition (Chick, 1985; Watson, 1991; Saunders, 1999; Rowland, 1993). Watson (1999) in a study of patients in general medical, surgical, orthopaedic and short-stay accident and emergency wards, reported 25% of patients consuming alcohol at levels in excess of the sensible drinking limits.

Five percent of the patients had previously received treatment for problem drinking. A further 20% were found to be drinking in excess of the sensible drinking limits (Health Education Authority, 1989) and were at risk of developing alcohol-related health problems, and the remaining 75% were in the low risk category (British Medical Association, 1995).


REFERENCES:

British Medical Association. (1995) Alcohol: guidelines on sensible drinking. London: British Medical Association.

Chick J, Lloyd G, Crombie E. (1985) Counselling problem drinkers in medical wards: a controlled study. British Medical Journal 290: 965 - 967.

Department of Health. (2000) Statistical Bulletin: statistics on alcohol: 1976 onwards. London: The Crown Office.

Freemantle N, Paramjit G, Godfrey C, Long A, Richards C, Sheldon T et al Brief interventions and alcohol use. (1993) Effective Health Care Bulletin. 7. Extracted from: Heather N, McAvoy B, Kaner E 2000 Phase IV: Implementing countrywide screening and brief alcohol intervention strategies in primary health care, England. WHO Collaborative Project on Identification and Management of Alcohol-Related Problems in Primary Health Care

Health Education Authority. (1989) That's the limit: a Guide to Sensible Drinking. London: Health Education Authority.


Lieber C. S. (1995) Medical disorders of alcoholism. New England Journal of Medicine 333: 1054-1065

Rowland N., Maynard A. K. (1993) Standardized alcohol education: a hit or miss affair? Health Promotion International 8(1):5-12.

Saunders J. B., Lee N. (1999) Opportunistic brief interventions. Medicine 27: 2

Watson HE, Kershaw P. W., Davies J. B. (1991) Alcohol problems among women in a general hospital ward. British Journal of Addiction 86: 889-894.

Watson H. E. (1999) A study of minimal interventions for problem drinkers in acute care settings. International Journal of Nursing Studies 36(5): 425-434.