Comment

Alcohol consumption is a considerable public health burden in the UK. According to the Department of Health (DH) (2008), the

consequences of alcohol misuse cost the country £2.7 billion pounds each year, with the annual cost to healthcare of alcohol abuse calculated as £1.6 billion pounds (DH, 2005; 2008, 2011). The increased number of patients being admitted with alcohol-related complications is costing the NHS 3% of its budget each year.

For a significant and growing number of people in the UK, alcohol consumption is a major cause of ill health, with more than 10 million people in England (31% of men and 20% of women) regularly drinking above the recommended alcohol limits (National Audit Office (NAO), 2008). The incidence of alcohol-related illness has risen over the past 20 years, with the National Institute for Health and Clinical Excellence (NICE) (2010) suggesting that 26% of adults not only drink above the recommended limits, but also drink in a manner that is actively harmful (impacts adversely on human physiology and health).

The Office for National Statistics (ONS) states that the number of alcohol-related deaths in the UK has risen since the early 1990s, from the lowest figure of 4023 (6.7 per 100 000 population) in 1992 to the highest of 9031 (13.6 per 100 000) in 2008 (ONS, 2011). These figures demonstrate the growing burden posed by alcohol abuse on NHS staff and resources.

Current Government recommendations state that men should drink no more than three to four units of alcohol a day, and that women should drink no more than two to three units a day. However, research suggests that many men and women exceed these recommended limits (DH, 2011). According to the DH (2011), regularly drinking above recommended daily limits significantly increases the risk of ill health and alcohol-related health problems.

Consequences of alcohol misuseThe health and social consequences associated with alcohol misuse are immense. Indeed, the British Medical Association (BMA) has described an ‘epidemic’ of alcohol misuse in the UK (BMA, 2008). NICE (2010) defined harmful drinking as ‘a pattern of alcohol consumption which is over the recommended weekly amount that causes mental or physical damage’. Excessive alcohol intake is associated with liver disease and liver cirrhosis. Although alcoholic liver disease can be slow and progressive, taking up to a decade to present itself with life-threatening symptoms, if the liver is subjected to excessive intake of alcohol over a long period of time, its ability to function normally is compromised.

Other causes of death associated with alcohol abuse include stroke, cancer, cardiovascular disease and accidental injury.

Alcohol and mental healthAlthough the effects of alcohol on the body can be serious and detrimental, the burden of excessive alcohol consumption doesn’t just affect physical health; the psychosocial impact of alcohol abuse has also emerged as a concern for health professionals. It has been reported that people who consume high amounts of alcohol are vulnerable to higher levels of mental health problems, and that excessive alcohol intake is a contributory factor in mental illnesses such as depression (Miller et al, 2011). Excessive alcohol consumption has also been linked to road traffic accidents, family breakdown, work, financial and legal problems, and domestic violence. Indeed, almost half of all victims of violence report that perpetrators were under the influence of alcohol (Motluk, 2004; Livingston, 2011). The health, economic and social burden of alcohol abuse is of significant concern.

What is being done?In 2010, the Government launched ‘The Coalition: Our Programme for Government’, containing several commitments to tackle the harmful use of alcohol. These include: banning the sale of alcohol below cost price, reviewing alcohol taxation and pricing to tackle binge drinking, doubling the maximum fine for under-age alcohol sales to £20 000, and overhauling the Licensing Act to give local authorities and the police much stronger powers to remove licences from premises that are causing problems.

Nurses’ roleWhile these measures may help address some of the problems associated with alcohol misuse, it is nurses who are best placed to tackle excessive alcohol intake and its associated problems (Ryder et al, 2010).

Nurses have a key role to play in promoting health and influencing the health of individuals and communities. According to the NAO (2008), early alcohol-associated interventions such as identification and advice can bring substantial health benefits and savings, and it has been shown that early intervention by specially trained nurses can reduce alcohol intake and positively assist people with alcohol-related problems (Ryder et al, 2010).

Where can we go from here?What is needed now is a strategy for dealing with excessive alcohol consumption in the UK, and the implementation of interventions to reduce the high

The health and psychosocial burden of alcohol abuse

212� British Journal of Nursing, 2012, Vol 21, No 4

Editorial Board

Russell Ashmore, Senior Lecturer in Mental Health Nursing, Sheffield Hallam UniversitySteve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, WrexhamChristopher Barber, Residential NurseDimitri Beeckman, Lecturer and Researcher, Florence Nightingale School of Nursing & Midwifery, King’s College LondonRuhi Behi, Head of School, School of Healthcare Sciences, University of Wales, BangorMartyn Bradbury, Clinical Skills Network Lead, University of PlymouthAlison Coull, Lecturer, Department of Nursing and Midwifery, University of Stirling, ScotlandWillie Doherty, CNS Continence Care, Park Drive Health Centre, Baldock, HertfordshireJane Fox, Independent Consultant, DerbyshireAlan Glasper, Professor of Child Health Nursing, University of SouthamptonAngela Grainger, Assistant Director of Nursing, King’s College Hospital NHS Trust, LondonMichelle Grainger, Ward Manager, Moseley Hall Hospital, BirminghamHelen Holder, Senior Lecturer, Nursing Studies, Birmingham City UniversityMina Karamshi, Specialist Sister in Radiology, Royal Free Hospital, HampsteadJohn Keady, Professor of Admiral Nursing, Northumbria University, Newcastle-upon-TyneAndrew McVicar, Reader, Dept of Mental Health & Learning Disabilities, Anglia Ruskin UniversityDanny Meetoo, Lecturer in Adult Nursing, University of SalfordMervyn Morris, Director, Centre for Mental Health Policy, Birmingham City UniversityCyril Murray, Senior Lecturer, University of SalfordAru Narayanasamy, Associate Professor, University of NottinghamMike Nolan, Professor of Gerontological Nursing, University of SheffieldAnn Norman, RCN Criminal Justice Services Nursing Adviser and Learning Disability Nursing Adviser (U.K)joy Notter, Professor, Birmingham City University, UK & Saxion University of Applied Science, NLLynn Parker, Independent Educational Adviser, Infection Control, SheffieldHilary Paniagua, Senior Lecturer, School of Nursing & Midwifery, University of WolverhamptonIan Peate, Head of School, Nursing, Midwifery and Healthcare, Thames Valley UniversityBernadette Porter, Nurse Consultant, Multiple Sclerosis, National Hospital for Neurology and Neurosurgery, UCLH NHS TrustJo Sharman, Operational Commissioning Manager, University Hospitals Birmingham NHS Foundation TrustJohn Tingle, HRS Reader in Health Law, Nottingham Law School, Nottingham Trent UniversityBernice West, Academic Director, School of Nursing and Midwifery, Robert Gordon University, AberdeenCatherine Whitmore, Research Nurse, Diabetes and Endocrinology, University of LiverpoolJohn Wilkinson, RCN Officer, Royal College of Nursing, Eastern RegionJo Wilson, Director, Wilson Healthcare Services, NewcastleCate Wood, Lecturer, Bournemouth University, PhD student at London School of Hygiene and Tropical MedicineSue Woodward, Lecturer, Specialist and Palliative Care, Florence Nightingale School of Nursing and Midwifery, King’s College London

British Journal of Nursing, 2012, Vol 21, No 4 213

Sarah Welton3rd�year�Nursing�Student,�University�of�Glamorgan,�Wales

Ray HigginsonChartered�Biologist�and�Senior�LecturerUniversity�of�Glamorgan,�Wales

burden of alcohol-attributable disease. Primary care trusts must have established drug and alcohol services, with nurses playing a key role in their delivery.

Although providing nursing care to patients who abuse alcohol is a complex and demanding task, nurses who possess the necessary knowledge and skills to undertake patient assessment and appropriate behavioural management techniques can have a positive impact on all those patients affected by alcohol. As a profession, nursing needs to continue to raise concerns about the serious health and psychosocial problems associated with alcohol abuse, and work with other professionals to improve alcohol intervention strategies.

Ceccanti et al (2002) have shown that nurses working in accident and emergency departments are best placed to recognize and treat patients affected by alcohol-related problems, such as acute alcohol intoxication (AAI), alcohol withdrawal (AW), and traumatic or spontaneous illness owing to acute or chronic effects of alcohol abuse. This highlights the central role that nurses can play in alcohol abuse treatment. Recently, the chief medical officer for Wales has identified tackling alcohol misuse as a major health priority. In a recent pilot study conducted in partnership between Cardiff University and the Welsh Government, hospital patients with a drink problem are to be identified and offered help by specially trained nurses. Working in trauma units, these specialist nurses will talk to all patients with an injury to identify alcohol misuse. The fast alcohol screening test (FAST) flags up drink-related problems, allowing the nurses to talk to patients about any drinking issues. Professor Jonathan Shepherd, director of the Violence and Society Research Group at Cardiff University, has recently stated that: ‘Alcohol misuse is a major problem in Wales. The death rate is alarming and far too high. We know from our own research that most people injured while intoxicated are young. Intervening early in a problem drinker’s life can make a real difference. Nurses working in injury clinics can be hugely effective in helping patients tackle alcohol misuse’ (Cardiff University, 2012).

It has been suggested that in order to meet the needs of patients who abuse alcohol, information on the dangers of excess alcohol

intake should be incorporated into preregistration nurse education and training (Hussein-Rassool and Rawaf, 2008).

Training on alcohol abuse screening, detection of alcohol problems and highlighting obstacles in the identification of alcohol abuse, as well as skills designed to assist in intervention should form part of preregistration nurse education.

BJN

BMA Board of Science (2008) Alcohol misuse: tackling the UK epidemic. http://tinyurl.com/74g8d39 (Accessed 13 February 2012)

Cardiff University (2012) Tackling alcohol abuse. http://tinyurl.com/7yjf576 (accessed 15 February 2012)

Ceccanti M, Nocente R, Diurni V, Pulimeno A, Torre R, Bertazzoni G (2002) The nurse’s role in the identification and management of alcohol abuser in the Emergency Department. Clin Ter 153(6): 389-96

Department of Health (2005) Alcohol Misuse Interventions: Guidance on developing a local programme of improvement. Crown Publishers, London. http://tinyurl.com/yvfhaa (accessed 13 February 2012)

Department of Health (2008) The cost of alcohol harm to the NHS in England: An update to the Cabinet Office (2003) study. Crown Publishers, London. http://tinyurl.com/5jjjtb (accessed 13 February 2012)

Department of Health (2011) Alcohol Statistics. http://tinyurl.com/73qru3s (Accessed 13 February 2012)

Hussein Rassool G, Rawaf S (2008) Educational intervention of undergraduate nursing students’ confidence skills with alcohol and drug misusers. Nurse Educ Today. 28(3): 284-92

Livingston M (2011) A longitudinal analysis of alcohol outlet density and domestic violence. Addiction 106(5): 919–25. EPub.

Miller M, Borges G, Orozco R et al(2011) Exposure to alcohol, drugs and tobacco and the risk of subsequent suicidality: findings from the Mexican Adolescent Mental Health Survey. Drug Alcohol Depend 113(2-3): 110–7

Motluk A (2004) Binge drinking among US adults. New Sci 183(2461): 28-33National Audit Office (2008) Reducing Alcohol Harm: Health services in England for alcohol misuse.

http://tinyurl.com/7bwesez (Accessed 13 February 2012)National Institute for Health and Clinical Excellence (2010) Alcohol-use disorders Diagnosis

and clinical management of alcohol-related physical complications. http://tinyurl.com/7zct3ym (Accessed 13 February 2012)

Ryder SD, Aithal GP, Holmes M, Burrows M, Wright NR (2010) Effectiveness of a nurse-led alcohol liaison service in a secondary care medical unit. Clin Med 10(5): 435-440

The Office for National Statistics (2011) Alcohol-related deaths in the United Kingdom, 2009. http://tinyurl.com/6nj6q93 (Accessed 13 February 2012)

More than 10 million people in England regularly drink above the recommended alcohol limits

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Copyright of British Journal of Nursing (BJN) is the property of Mark Allen Publishing Ltd and its content may

not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written

permission. However, users may print, download, or email articles for individual use.