Alcohol screening and brief interventions in primary care Dr Richard Watson (Presented by Catriona Loots

Only one glass! Dram = unit! Availability – garages, super markets, hours Relative cost % alcohol – increased Culture – 43% pop drinking above guidelines In 2012/13, there were an estimated 94,630 alcohol-related primary care consultations by 48,420 patients, a substantial fall from 109,170 consultations by 57,470 patients in 2011/12. Forty-six percent of the patients seen for alcohol misuse in 2012/13 were aged between 45 and 64, but consultation rates were highest for those aged 65 and over. In patients aged between 18 and 44 who consulted their GP for alcohol misuse in 2012/13, men were more than twice as likely to consult for anxiety or for depression compared to all males who consulted a GP, whereas females were around three times more likely to consult for anxiety or for depression compared with all females who consulted a GP. There were two-and-a-half times more patients consulting for alcohol misuse in the most deprived quintile compared with the least deprived quintile. 2012/2013 https://isdscotland.scot.nhs.uk/Health-Topics/Drugs-and-Alcohol-Misuse/Publications/2014-01-28/2014-01-28-ScotPHOAlcohol-Summary.pdf?70159548522

UK Alcohol Consumption Litres of pure alcohol consumption per capita Alcohol sales enough for every person 16+ to be exceeding male weekly guidelines .

Global drinking and European drinking, 2005 3rd Greatest risk factor -disease & disability 3–6 litres 6–9 litres 9–12 litres 0–3 litres 12–15 litres 15–25 litres Per capita alcohol consumed in litres of pure alcohol, 2005 Averages 2004–2006 for Comparative Risk Assessment WHO Global Information System on Alcohol and Health (GISAH)

Patterns of consumption 2005 Least risky = regular drinking, often with meals and without infrequent heavy drinking bouts Most risky = infrequent but heavy drinking outside of meals

Alcohol Related Deaths 15 of the 20 local areas in the UK with highest male alcohol-related death rate 1998-2004 are in Scotland: Glasgow City Inverclyde West Dunbartonshire Renfrewshire Dundee City The map (the ‘red face of Scotland’) shows in red areas in the UK with the higher death rates from alcohol. The top 5 areas in the UK are all in Scotland. Notably a problem of both rural and urban areas. Scottish average (43.4%), 2013 CMO – alcohol liver disease one of Scotland’s ‘big killers’

Compared to Europe

Causal factor 60 types of Disease & Injury & component in 200

Alcohol Misuse impact Child neglect HEALTH EMPLOYMENT CRIME EDUCATION JUSTICE HOUSING /FIRES Child neglect HEALTH EMPLOYMENT CRIME HEALTH EDUCATION EDUCATION

Who drinks by age group? 50% men 30% women exceed limits

Who Drinks by SIMD? Alcohol sales enough for every person 16+ to be exceeding male weekly guidelines .

Alcohol related deaths by deprivation Greatest impact on most deprived communities even though they don’t necessarily drink the most. http://www.shaap.org.uk/UserFiles/File/Briefing%20-%20Alcohol%20&%20Deprivation%20-%20web%20version.pdf

Scotland’s Alcohol Policy Achievement £90 million new investment in Alcohol Treatment Alcohol screening and brief interventions in A&E, Antenatal and Primary Care settings 461,000 ABI delivered 2008 -2013 (80% in Primary Care) (LES) Licencing act and sales restrictions Minimum pricing bill!

Guidelines Sensible limits are expressed in units. Beyond these limits the risk of alcohol related harm rises. Daily benchmarks developed in addition to weekly limits. Note that sensible does not mean the same as safe. There can be an increased risk even drinking below sensible limits, such as for certain cancers.

Why do brief interventions? Very good evidence that brief interventions are effective. Brief interventions in primary care can reduce total alcohol consumption and episodes of binge drinking in risky drinkers for periods lasting up to a year. The reduction in alcohol consumption is of the order of 15-35%. SIGN Guideline 74, 2003 Notes and Discussion points SIGN Guideline 74 notes that there is very good evidence for the effectiveness of brief interventions, particularly in primary care settings (general practice and community nursing) and in Accident and Emergency departments (SIGN, 2003). This does not mean that brief interventions do not work in other settings, but merely that the research has not been done to the same extent, so we don’t know! Brief interventions are appropriate for risky drinkers - that is, people who are regularly exceeding the recommended drinking guidelines. The effect of a brief intervention in reducing alcohol consumption is small, but can last for up to a year. At a population level, small changes in consumption by many people could make a big difference to the level of alcohol problems in society as a whole. SIGN 74 is available at www.sign.ac.uk/pdf/sign74.pdf

Why do brief interventions? Very brief or minimal (5-10 minute) interventions are as effective as longer ones. “The benefits of brief interventions in normal clinical settings are similar to those in research studies with greater resources.” Cochrane Review of Brief Interventions in Primary Care; Notes and Discussion points A recent rigorous review of the evidence (Cochrane Review of Brief Interventions n Primary Care - Kaner et al., 2007) concluded that short discussions are as effective as longer or repeated sessions and, crucially, that the benefits witnessed in large research studies are similar in realistic everyday settings.. Full Cochrane reference: Kaner EFS, Dickinson HO, Beyer F et al. (2007). Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database of Systematic Reviews. Issue 2. Art. No.: CD004148. DOI: 10.1002/14651858.CD004148.pub3. The full Cochrane report is available at http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004148/pdf_fs .html

DVD