Alcohol problems in young people

Greater awareness of drinking problems is needed, say Professor Eileen Kaner and Ruth McGovern.

Approximately 90 per cent of people in the UK drink alcohol, and most of the time the majority have no difficulties.

Alcohol can be an aid to sociability and relaxation. Indeed, there are even some health benefits to moderate or low-risk drinking, such as reduced risk of death from heart disease and stroke for those over 40.

Heavy drinking
However, there is a very wide range of alcohol-related harm caused by frequent heavy drinking and/or high-intensity, binge drinking (see box), including health and social problems.

In 2004, the national alcohol needs assessment found that 23 per cent of 16- to 64-year-olds were drinking above the recommended sensible drinking levels which equated to 7.1 million people, while a further 1.1 million were dependent drinkers.

Young people (aged 16-24 years old) are particularly prone to heavy drinking, with 33 per cent drinking over the recommended levels and 8 per cent drinking dependently. This compares to 15 per cent and 1 per cent, respectively, in older people aged 55-64 years.

Furthermore, there is recent evidence that the amount of alcohol drunk by young people each week has more than doubled since 1990.

Levels of risk and alcohol consumption
Level of risk due to drinking alcohol
Definition
Men
Women
Low riskNot regularly drinking >3-4 units per day and not regularly drinking >21 units per weekNot regularly drinking >2-3 units per day and not regularly drinking >14 units per week
Increased riskRegularly drinking >3-4 units per day or regularly drinking >21 units per week - but not drinking at levels incurring the highest riskRegularly drinking >2-3 units per day or regularly drinking >14 units per week - but not drinking at levels incurring the highest risk
High riskRegularly drinking >50 units per week or
regularly drinking >8 units per day
Regularly drinking >35 units per week or regularly drinking >6 units per da

Binge drinking
High-intensity drinking or drinking to intoxication

Drinking eight or more units in a single session

Drinking six or more units in a single session

Early identification
The government published Models of Care for Alcohol Misusers in 2006 to help improve prevention and treatment of alcohol-related problems.

This work highlighted the importance of early identification of heavy drinking and brief interventions available to help reduce consumption levels and improve health and well-being across the population.

Primary care is a key setting for brief alcohol intervention and there is a large evidence base from 29 randomised, controlled trials to support this work. However, research shows that GPs and other health professionals under-identify heavy drinking in their patients, and particularly in young people.

Given time pressures in primary care, methods of identifying alcohol risk and harm need to be quick and accurate. Several simple questionnaires, containing between one and 10 questions, are available for use by health professionals and these have very high accuracy rates.

People aged 16-24 are particularly prone to heavy drinking

Simple brief intervention
Simple brief intervention is concerned with increasing awareness about alcohol in relation to unit intake and the common effects of regularly exceeding these amounts.

The intervention requires the clinician to deliver structured advice and information about ways to reduce risk, which is framed positively in order to avoid judgment.

For example, a male patient who is consuming eight units twice per week would be advised that they are exceeding the recommended daily levels, however the health professional should acknowledge that he is drinking within the weekly recommended levels and having two alcohol-free days.

Extended brief intervention
Extended brief intervention has a motivational component and it is concerned with eliciting change talk from the patient and can be better described as lifestyle counselling rather than advice.

Here the clinician's role is to provide an opportunity for the patient to consider their own drinking behaviour, how they feel about change and how, if they are agreeable, they could achieve change.

Empathic approach
These interventions are effective at reducing heavy drinking in patients attending primary healthcare and who are not consciously seeking help for alcohol problems.

The principles underpinning brief intervention are concerned with approaching the individual from an empathic value base. It is essential to avoid stereotyping patients, especially young people who are often considered to be anti-social binge drinkers. This approach is important because most patients are unaware their drinking might be affecting their health or well-being.

Long-term harm
Addressing alcohol problems is challenging, but the existence of preventable health problems requires that heavy drinking is not accepted as a 'normal' part of young adulthood. Primary healthcare has an important opportunity for early intervention in young people to reduce future harm relating to alcohol.

  • Professor Kaner is professor of public health research and Ms McGovern is a senior alcohol health worker at the University of Newcastle
  • This topic falls under section 8 of the GP curriculum 'Care of Children and Young People', www.rcgp-curriculum.org.uk
  • Contact Emma Quigley at GP Education on (020) 8267 4805 or email GPeducation@haymarket.com

Learning points

1. Young people are particularly prone to heavy drinking.

2. Use interventions such as questionnaires to identify alcohol risk.

3. Brief intervention models can be used to help patients consider their alcohol consumption.

4. Avoid stereotyping young alcohol users.

Resources

  • The Alcohol Needs Assessment Research Project Department of Health, 2005.
  • Models of Care for Alcohol Misusers (MoCAM) (National Treatment Agency for Substance Misusers, 2006).
  • Kaner E, Beyer F, Dickinson H et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database of Systematic Reviews 2007; 2: CD 004148.

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