Tackling problem drinking

One in four people, a total of 10 million – is estimated to be putting their health at risk by drinking more alcohol than the recommended limits. 

GPs are now being advised to question new patients about their drinking habits when they join a surgery, pharmacists are being told to question patients when prescriptions are being reviewed and hospital doctors are to ask patients who come into A&E over whether their injuries might be related to drinking. 

However, many patients resent the implication of being questioned and many grossly underestimate their intake. 

With the pressure to react to a growing number of urgent needs and deal with the increasing strain on the NHS, preventative and specialist services have struggled to keep pace with demand. 

It is clear that new and more effective ways of treating problem drinking are needed.  The Department of Health estimates that changing the way we deliver alcohol-related services could save PCTs up to £650,000 a year. The NHS Confederation and the Royal College of Physicians have highlighted that preventative measures could reduce demand and improve the health of the population both today and tomorrow.

So how can this be achieved?

A new way of thinking

The Department of Health’s Health Profile of England 2009 showed that liver disease is on the increase as a result of binge drinking and is killing three times as many people in England as in Holland. 

Since 2005 the health service in Holland has been taking an innovative approach to solving problem drinking. It has been largely funding patients to receive treatment through Tactus, a pioneer in evidenced based, online addiction treatment. It has been involved in addiction for over 100 years and now treats 2,500 patients a year online for alcohol and other addictions. 

A UK version of the service is now available. Like its Dutch equivalent, Lookatyourdrinking.com provides an online therapy programme for those who are concerned about their drinking habits. Therapists work with clients to find individual solutions, whether it is cutting down alcohol consumption or quitting altogether. The programme is based on cognitive behavioural therapy which has proven to be very effective in face-to-face treatment.

This approach has shown to be particularly effective in reaching traditionally hard to reach groups having treated twice as many women and people with jobs, than more conventional face-to-face treatments. The programme can be undertaken anonymously by those who are concerned about their drinking habits. It overcomes the traditional reasons for not seeking treatment which include the stigma associated with alcohol addiction and treatment, patients not having time (particularly busy professionals), access barriers, delay in treatment and/or not knowing where to go for services.   

The improving access to psychological therapies programme aims to increase the number of people receiving treatment and in recovery and reduce the numbers of those on sick pay and benefits.  As part of its alcohol strategy, the Department of Health has introduced the Vital Signs indicator to encourage a range of measures such as commissioning services that improve early identification and referral to specialist treatment for patients with alcohol-related health issues. GP practices are particularly well placed to make a difference in reducing alcohol-related harm and identifying patients early, as well as managing their care. 

E-therapy is an effective intervention for problem drinking that can be delivered to a large population who would otherwise not seek help.  By engaging traditionally harder to reach groups, they are often reached at an earlier stage of their addiction problem, therefore problems are less severe and treatment more effective and cost effective. 

Yale University research has shown that a computer-assisted programme to teach drug and alcohol abusers skills to change their behaviour has been shown to help them remain abstinent significantly longer than others who received traditional counselling only. 

The use of online therapies is growing. NICE is already backing a number of computer-based packages proven to effectively treat anxiety, panic, phobias and mild depression.  Psychologists are also increasingly looking at other ways to provide services including psychotherapy, counselling, consulting and supervision. Overall email use more than tripled among practicing psychologists between 2000 and 2008. 

Alcohol misuse typically costs the NHS £2.7 billion per year. This includes the cost of treating health problems arising from alcohol consumption, A&E admissions due to alcohol related injuries, ambulance costs and drugs to treat alcoholism.  A five to seven day hospital admission for a detox programme can cost around £2,000 for this one aspect of treatment alone, and a patient could require this treatment many times.