Alcohol misuse: tackling the UK epidemic - London

BMA Board of Science
Box 6 – good practice in the detection and management of alcohol misuse
In St Mary’s Hospital, London, all patients presenting to A&E with one of the targeted
conditions (falls, collapse, head injury, assault, gastrointestinal problems, ‘unwell’, psychiatric
problems, cardiac symptoms and accidents) are screened for alcohol misuse using the PAT.
Individuals who score a positive result (indicating hazardous or harmful drinking) are offered
the opportunity to have a session with the A&E’s alcohol health worker within 24 to 48 hours.
This worker is a trained nurse who carries out a more in-depth assessment concerning the
individual’s lifestyle and alcohol use. The worker then delivers a brief intervention of education
and counselling concerning the patient’s use of alcohol. A review of this model found the
introduction of this opportunistic screening and management resulted in lower levels of
alcohol consumption over the following six months and reduced re-attendance rates at the
A&E department. 231
At the Royal Liverpool Hospital, an alcohol specialist nurse is employed to respond to alcoholrelated
referrals from A&E, clinics and ward areas throughout the hospital. The main aims of
the model are to:
optimise medical management of alcohol-related attendance and admissions
develop staff attitudes and knowledge about alcohol misuse
provide patients with timely appropriate and effective clinical pathways of care
reduce overall alcohol-related hospital admission and attendance
reduce length of stay for alcohol-related admissions.
An assessment of interventions by the specialist nurse found that they reduced mean daily
alcohol consumption, reduced re-attendances, and improved staff attitudes and knowledge. 221
Specialist alcohol treatment services
For individuals with more severe alcohol problems and levels of dependence, specialised alcohol
treatment services have been found to be effective and provide better outcomes for individuals
who are alcohol dependent compared to untreated individuals, including significant reductions in
114, 217, 232
alcohol use and related problems. Specialised treatment services consist of both therapeutic
approaches (eg relapse prevention) and management components (eg detoxification facilities,
inpatient residential programmes and outpatient clinics) that can be provided within the healthcare
system or by private providers. Evidence suggests that the most effective specific treatment
modality is through cognitive behavioural treatments (eg behavioural self-control training), while
pharmacotherapies (eg disulfiram) can be considered as adjuncts to cognitive behavioural
114, 217
treatments.
There has been very little research into the cost-effectiveness of alcohol treatment services;
however, cost offset studies primarily conducted in the USA have found that alcohol dependent
individuals and their families use healthcare services more than non-alcohol dependent individuals
of the same age and gender, and their demand for healthcare services declines following
114, 233
treatment.
Not all individuals with severe alcohol problems will recognise or agree that they have an alcohol
misuse problem, or that they require treatment. It is essential, that individuals identified as having
severe alcohol problems or as being alcohol dependent are offered referral to specialised alcohol
Alcohol misuse: tackling the UK epidemic 65