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Hard to swallow

New statistics show that excessive alcohol consumption is still a problem for many people, so what can community pharmacy teams do to help them recognise and moderate their intake?

The number of people in Scotland whose death was caused by alcohol has risen again to the highest level in 14 years. The latest figures from National Records of Scotland (NRS) show 1,276 people died from conditions caused by alcohol in 2022 – two per cent more than in 2021, which was itself the highest level since 2008.

“The crushing news that the number of people who lost their lives to alcohol in Scotland has risen again is a grave reminder that we are in the midst of a public health crisis with alcohol,” says professor Ian Gilmore, chair of the Alcohol Health Alliance UK. “Each one of the 1,276 deaths was entirely preventable and presents a tragic loss for the loved ones and communities left behind.”

Following this news, professor Gilmore also calls for “urgent action to improve access, quality and outcomes of treatment”, as well as “evidence-based prevention policies such as the continuation of Minimum Unit Pricing, adequate alcohol duty and restrictions on marketing… to protect children, families and communities from the increasingly devastating harms caused by alcohol”.

The health implications of alcohol

Alcohol is a toxic chemical that can have a wide range of adverse effects on almost every part of the body. Drinking more than the low-risk guidelines – of fewer than 14 units a week for men and women – on a regular basis increases the risk of serious health conditions including:

 Cancers of the mouth, upper throat, larynx, oesophagus, breast, liver and bowel

  •  Stroke
  •  Heart disease
  •  Liver disease
  •  Damage to the nervous system
  •  Pancreatitis
  •  Mental health problems.
  • Binge drinking – drinking a lot of alcohol in a single occasion – is especially harmful and can increase the risk of:
  • Accidents
  •  Misjudging risky situations
  •  Loss of inhibitions and increased risk-taking
  •  Becoming a victim or a perpetrator of crime
  •  Self-harm and suicide.

Drinking too much alcohol can also contribute to social problems such as unemployment, relationship breakdowns, domestic abuse and even homelessness.

Addressing alcohol addiction and accessing support

The UK chief medical officers recommend that both men and women do not regularly drink more than 14 units a week – equivalent to six pints of four per cent beer, or six 175ml glasses of 13 per cent wine – to keep health risks at a low level. They also suggest that:

  •  If you regularly drink as much as 14 units per week, it's best to spread your drinking over three or more days, as one or two heavy drinking episodes a week increase the risk of death from long-term illness, and from accidents and injuries
  •  If you wish to cut down the amount you drink, a good way to help achieve this is to have several drink-free days every week. “If customers are concerned about their level of drinking – or someone else's – pharmacy teams can refer them to the pharmacist, so they are able to discuss services such as CBT and other treatments available,” says Reshma Malde, superintendent pharmacist at John Bell & Croyden.

In addition, the pharmacist can help by assessing the person’s level of alcohol intake using tests such as the:

  • Alcohol use disorders identification test – a widely used screening test that can help determine whether you need to change your drinking habits
  • Alcohol use disorders identification test consumption – a simpler test to check whether drinking has reached dangerous levels
  • “Pharmacy staff can also offer contacts of charities and support groups across the UK that provide support and advice for people with an alcohol misuse problem,” adds Reshma. For example:
  • Drinkline – the national alcohol helpline on 0300 123 1110
  • Alcohol Change UK 
  • Alcoholics Anonymous helpline on 0800 9177 650
  • Al-Anon Family Groups helpline on 0800 0086 811
  •  Drinkaware 

A role for pharmacy teams

Dr Richard Piper, chief executive of Alcohol Change UK, says community pharmacy teams have an important role to play in raising awareness of the harm caused by alcohol.

“Getting involved in Alcohol Awareness Week, which is run and managed by Alcohol Change UK in July each year, is a great place to start,” he says. “Some people may also benefit from taking a break from alcohol. This can be beneficial in its own right, but aiming for a month off alcohol as part of a well-designed behaviour change programme is so much more effective and that’s where Dry January can make a significant difference.”

Evidence shows that Dry January is an effective and lasting way to cut down on alcohol intake with 70 per cent of those taking part still drinking less six months later. “Interestingly this only applied to those who did the campaign with support from Alcohol Change UK,” says Richard. “Those who take part in the campaign get access to lots of free tools and resources to make Dry January a great experience, such as the free Try Dry app, daily coaching emails, a vibrant private online community, inspiring stories and more.”

Research also suggests some significant health benefits from taking a month off alcohol, including lower blood pressure, cholesterol, diabetes risk, as well as lower cancer-related proteins in the blood.

“Pharmacy teams play a crucial role in raising awareness about the health implications of alcohol consumption as they are often the first point of contact for individuals seeking advice on various health-related issues, including alcohol use,” says Jacquie Lee, Numark medication safety officer and information pharmacist.

“The majority of pharmacies have a private consultation room where customers can discuss issues in confidence with one of the pharmacists who can offer advice and support, and pharmacies should aim to create a supportive and non-judgmental environment where customers can feel comfortable discussing their concerns about alcohol use and seeking help.”

The health promotion zone within pharmacies can be used to provide information and educational materials to customers about the risks and health consequences associated with alcohol consumption. “Taking part in alcohol awareness campaigns could incorporate the use of pamphlets, posters and signposting to services available for customers to access,” adds Jacquie. “There are various phone apps that can help track alcohol consumption such as ‘NHS Drink Free Days’.”

Pharmacy staff can also promote responsible drinking guidelines, such as recommended limits for alcohol consumption and the importance of moderation.

“Healthy living advisors can give advice on knowing your units to help customers and patients stay in control of their drinking and maintain safe levels of alcohol consumption,” says Reshma Malde, superintendent pharmacist at John Bell & Croyden. “They can also advise on short and long term risks of excessive alcohol consumption when responding to symptoms related to accidents and injuries possibly caused by excessive alcohol consumption and talk about the risk of serious health conditions as a result of prolonged alcohol misuse – although staff should refer patients to the pharmacist if there is potential that they are a victim of violence such as domestic abuse or displaying violent behaviour.”

Alcohol signposting and support

Pharmacy teams should not be surprised if they regularly come across customers who need signposting to appropriate support services, such as addiction counsellors, support groups, or healthcare professionals who can help them with alcohol-related problems or who are seeking support to reduce their alcohol consumption.

“It is a good idea in community pharmacies to have a folder with signposting details to hand so that customers can be referred quickly,” says Jacquie. “The NHS is a good starting point as it signposts people to helplines such as Drinkline, the national alcohol helpline, and Alcohol Change UK’s website provides free digital resources to help people in the community to drink more healthily.”

Richard adds that signposting people to Alcohol Change UK’s free behaviour change programme can be particularly helpful, especially for hazardous and harmful drinkers, and “can help people successfully cut back on their drinking longer-term”.

Then there is the Try Dry app, which allows people to track their units, calories and money saved through Dry January, and set custom goals for managing their drinking year-round.

There are also a number of alcohol screening tools available. “Some of the most well-tested and widely used ones are the various forms of the AUDIT questionnaire,” says Richard. “As well as straightforward quantitative questions, such as how often someone has a drink containing alcohol, the AUDIT tool also deals with more personal questions – such as whether someone has found themselves unable to stop drinking once they had started, or whether they have failed to fulfil an obligation because of drinking.

“Not one of these questions on its own will produce a definite answer as to whether a patient has an alcohol problem but taken together, they give an indication of whether someone needs to cut back on their drinking.”

Alcohol Change UK has a 'Check your drinking' tool based on the AUDIT on its website which is a quick self-test for people to check if their drinking is likely to be impacting their health and lets users know if it would be a good idea to cut back.”

“There are also a range of resources in the Alcohol Change UK shop that can support community pharmacy’s public health campaign,” he continues. “Such as posters and the popular 'Rethink your drink' scratch cards (based on the AUDIT) which includes a handy unit guide to help people better understand the low risk drinking guidelines and check how many units are in their drinks.”

As front line trusted healthcare providers, community pharmacy staff have the potential to play a significant role in providing information and guidance to anyone who wants to moderate their alcohol consumption – and there’s no need to wait until the start of a new year to get people thinking about getting their drinking habits in check.

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