The Potential Role of the Doctor

Doctors are potentially not just providers of treatment for those with alcohol-related problems, they are also `gatekeepers' into treatment services and usually the leaders of the multidisciplinary teams involved. Additionally, doctors are well placed to act as advocates for alcohol problems prevention and treatment both within health services and more widely.

Alcohol impinges on a wide range of medical specialisms: accident and emergency; general medicine, general surgery, cardiology, neurology, dermatology, obstetrics and gynaecology, paediatrics, geriatrics, chest medicine, biochemistry, toxicology, haematology, public health, pathology and psychiatry. 4

In our report `Alcohol Problems in the Family' 5, we estimated that around 42 million adults in the European Union will experience alcohol abuse or dependence during some period of their lives. If the assumption is made that each problem drinker adversely affects only one other person, then 84 million Europeans will experience serious problems from either their own or another's drinking. In reality, of course, problem drinkers are likely to affect more than one other person.

People with alcohol-related problems appear in large numbers in clinical settings. Problem drinkers consult family doctors around twice as often as matched controls, especially because of psychological problems and acute injuries. 6 The partners and children of problem drinkers are also disproportionately heavy users of health and social services 5.

Internationally, around 10-20 per cent of patients seen in primary care settings have alcohol-related problems. 7 There is also high prevalence of alcohol problems in secondary care institutions. In the UK, more than 25 per cent of male in-patients in general medical wards have a current or previous alcohol problem, and around 40 per cent of attenders in Accident and Emergency Departments have consumed alcohol before their attendance, 32 per cent having a blood alcohol level over the legal limit for driving. 8

Similarly high prevalence rates have been reported for other European countries. In Portugal, 40 per cent of male and 10 per cent of female admissions to general hospitals are alcohol-related, and in Denmark a recent study of adult medical in-patients in Copenhagen found nearly half (48 per cent) of the men and 16 per cent of the women met criteria of alcohol problems. 9

With regard to psychiatric morbidity, international comparisons are made difficult by differing policies in relation to numbers of beds available and admissions procedures and, in some cases, the existence of policies designed to minimise in-patient admissions to hospitals. However, the available information suggests that alcohol-related diagnoses comprise substantial proportions of the total psychiatric case-load in all EU countries. Thus, for example, in the Republic of Ireland alcohol-related diagnoses comprise 25 per cent of all psychiatric admissions - one third of all male admissions. In Denmark, around 16 per cent of psychiatric admissions are alcohol-related, in Finland 32 per cent, in Portugal 40 per cent and in Luxembourg 43 per cent. 10

Doctors are thus well placed to identify patients with alcohol problems. Not only do they have frequent contact with problem drinkers: patients expect doctors to ask them about their alcohol consumption and believe that they have a right to do so. 11, 12

References:

4 I.B. Glass - Crome: Alcohol misuse as a challenge to medical education: a belated remedy. British Medical Bulletin (1994) Vol.50 no.1.
5 Alcohol Problems in the Family: A report to the European Union.
Eurocare 1998.
6 B.R. Rush. (1989) The Use of Family Medical Practices by patients with drink problems. Canadian Medical Association Journal 140. 35-39.
7 Saunders et al: Alcohol Consumption and Related Problems among primary health care patients: WHO collaborative project on early detection of persons with harmful alcohol consumption etc.
8 'Tackling Alcohol Together' Society for the Study of Addiction. Free Association Books. 1999.
9 S.D. Nielsen et al: Prevalence of alcohol problems among adult somatic in-patients in a Copenhagen hospital. Alcohol and Alcoholism Vol 29 No.5. Sept 1994.
10 Counterbalancing the Drinks Industry. Eurocare 1995.
11 K. Slama et al: Community views regarding the role of general practitioners in disease prevention. Family Practice 6. 203-209.
12 Prevalence detection and treatment of alcoholism in hospitalised patients. Journal of the American Medical Association. 261. 403-407 1989.