In the past year, it has been difficult to open a newspaper without being faced with headlines about the UK's binge-drinking culture.
One helpful tool to identify dependence on alcohol is to ask the patient whether in the previous year they have had a strong urge to drink, experienced growing tolerance to alcohol, persisted in drinking even though it was causing them harm, drunk early in the morning or when alone, neglected other activities and interests in order to drink, or suffered withdrawal symptoms such as nausea, shaking or fitting.
A positive answer to three or more of these questions suggests alcohol dependence. Other patients may drink enough to cause actual physical or psychological harm without being dependent on alcohol. They can be defined as 'problem drinkers'.
A single binge episode of drinking (more than eight units for a man or six for a woman) increases the likelihood of accidental or deliberate self-harm, stroke, hypoglycaemia, fitting and brain damage.
Previous weekly recommended limits for alcohol (21 units a week for men and 14 units a week for women) failed to make clear the damage that could be done by binge drinking.
Extended opening hours
In 2004, the Academy of Medical Sciences published a report, 'Calling Time', which called on the government to address levels of alcohol consumption as a whole, rather than just targeting heavy drinkers.
The report highlighted the direct and indirect costs of alcohol abuse, including 70 per cent of cirrhosis deaths (which have risen nine-fold in young people since 1970) and 150, 000 hospital admissions a year and up to one third of all hospital A&E attendances.
The government's response has been to extend licensing hours under the new Licensing Act brought into force in November 2005. The theory is that drinkers tend to drink to excess just before closing time, and that 'staggering' closing times will reduce this temptation. However, other countries which have longer opening hours have all seen an associated increase in average alcohol intake, which in turn has been linked with increased levels of alcohol abuse.
Despite all the publicity given to (mostly young) binge drinkers, alcohol abuse still carries a huge stigma. In primary care, simply making clear your willingness to talk openly will often give the patient permission to broach the subject.
Strategies include displaying leaflets about alcohol and problem drinking and a poster with up-to-date details of local voluntary bodies.
There should also be non-judgmental questioning about alcohol intake in new patient registration checks.
GPs should take every opportunity to highlight the role of alcohol in health and be aware of patients presenting with multiple minor accidents or requesting frequent time off work.
KNOW THE LIMITS
Recommended limits for alcohol
Men 3-4 units 21 units
Women 2-3 units 14 units
EFFECTS OF ALCOHOL EXCESS
- Dependency/withdrawal symptoms
- Liver disease
- Gastritis/peptic ulceration
- Heart disease
- Malnutrition and infections
- Clotting disorders
- Oesophageal varices
- Peripheral neuropathy
- Foetal abnormalities
- Encephalopathy/chronic brain syndromes
- Accidental or deliberate injury.