NIHR: Public health messages on alcohol need to consider how and why people drink, not just how much

NIHR | June 2020 | Public health messages on alcohol need to consider how and why people drink, not just how much

Public health messages about alcohol could be more effective if they reflect how and why patients drink, rather than simply focusing on how much alcohol is being consumed. There may be a need for more relevant public health campaigns to raise awareness of the long-term consequences of heavy drinking.  

Study author

I found patients’ perspectives on alcohol guidelines interesting, in terms of how flexibly they were interpreted in everyday life. Public health messages around risk are incredibly complicated to communicate.

We would suggest investing in well-designed social marketing campaigns that reinforce current drinking guidelines. It is also important to look into the various reasons for increased alcohol consumption during the COVID-19 pandemic, and the best preventive advice to give in this context.

Amy O’Donnell, Senior Research Associate, Population Health Sciences Institute Faculty of Medical Sciences, Newcastle University

GPs can help patients reduce their drinking by providing brief advice during a routine appointment. But the majority of people who regularly drink more than 14 units a week (the recommended limit in the UK) have never received advice on alcohol from their doctor. 

Many people are not aware of the health risks linked to heavy drinking such as cancer or heart disease. During the COVID-19 crisis, there is concern that some people are drinking more than usual.

What’s the issue?

People tend to reduce the amount of alcohol they drink if they receive advice from their GP. But fewer than one in ten heavy drinkers say they have been given advice on alcohol from a doctor or nurse. 

Several studies have explored the challenges that GPs and nurses experience when delivering advice on alcohol. They suggest that lack of time and training are problems. But there is less understanding of how patients feel when they are asked about their drinking and what kind of advice they find most useful.

What’s new?

Researchers interviewed 22 adults between 25 and 75 years of age in North East England. They had all previously been asked about their drinking or received alcohol advice from their GP or nurse. The researchers looked for key themes in what their interviewees said. They aimed to understand what people think about discussing alcohol in a routine appointment, and whether they feel the alcohol advice provided is useful.  

The researchers found that many people had little understanding of the long-term health risks of heavy drinking, such as cancer and heart disease. Patients were aware that UK guidelines recommend no more than 14 units of alcohol a week. But they often did not think of themselves as problem drinkers even if they regularly exceeded this limit.  They believed that the limit should depend on the individual drinker’s age, gender or size.  They thought harmful drinking was less about the quantity consumed and more about a person’s emotional relationship with alcohol. They associated problem drinking with ‘needing’ to drink and drinking to become ‘drunk’. 

Patients did not mind being asked about their alcohol consumption by a nurse or GP, but they did not always find the advice helpful. Patients were more likely to discover tips and techniques to reduce their drinking for themselves, via friends and family, rather than from medical advice.   

Why is this important?

Patients were generally happy to discuss alcohol with their GP or nurse and to be given advice on drinking. Doctors and nurses may benefit from training on how to give alcohol advice to ensure they are providing patients with practical tips. Questions about how and why patients drink rather than simply focusing on how much may be helpful. Healthcare professionals could talk with the patient about when they are most likely to drink heavily and suggest ways to reduce their alcohol consumption in these situations. During the COVID-19 crisis, suggestions to limit heavy drinking in the home may be particularly important.  

Patients remain unaware of the health risks of heavy drinking. More relevant public health campaigns to raise awareness around alcohol harm, such as the link between drinking and cancer, may be needed.

What’s next?

One in three (36%) furloughed workers are drinking more since lockdown began, according to charity Drinkaware. Researchers want to better understand how the pandemic is affecting people’s drinking habits and how GPs can help.

New research could explore what triggers drinking during the pandemic and whether alcohol advice can be delivered as effectively via video or telephone appointments as when delivered face-to-face. Dr Amy O’Donnell is contributing to an ongoing Europe-wide survey led by researchers in Germany and Spain to investigate alcohol consumption during the pandemic.  

Research into the most effective types of alcohol advice would be useful. Further work using voice and video recordings of GP-patient consultations could help determine which tips are most likely to be taken on board (Source: NIHR). 

NIHR Public health messages on alcohol need to consider how and why people drink, not just how much

Full paper available from BMC Family Practice

COVID-19: guidance for commissioners and providers of services for people who use drugs or alcohol

This guidance outlines COVID-19 advice for commissioners and service providers involved in assisting people who are dependent on drugs or alcohol or both| Public Health England and Department of Health and Social Care

  • drug and alcohol services do not need to close at the current time and are important to keep operating as they protect vulnerable people who are at greater risk from coronavirus (COVID-19) and help reduce the burden on other healthcare services
  • services should keep face-to-face contacts between staff and service users to a minimum and minimise the use of biological drug testing and breathalysers, where safe to do so
  • follow up-to-date guidance for infection prevention and control, including hand-washing, surface-cleaning, isolating people and sending staff home
  • arrangements for prescribing and dispensing of medicines used in drug and alcohol treatment will need to be changed to take account of service and pharmacy closures, staff unavailability, patients having to maintain social distance or self-isolate, including the most vulnerable being shielded and the need to reduce the spread of COVID-19
  • measures to reduce drug and alcohol-related harm, such as needle and syringe programmes (NSP), take-home naloxone, thiamine, advice on gradual reduction of alcohol consumption and e-cigarettes should all be increased where possible
  • drug and alcohol treatment staff are included in the government’s definition of key workers whose children can – if they cannot be kept safe at home – continue to attend school
  • usual expectations on services for local monitoring and reporting, contract and performance management and contract re-tendering can all be scaled back to enable services to focus on delivery.

Full detail: COVID-19 guidance for commissioners and service providers for those dependent on drugs or alcohol

First UK-wide guidelines for alcohol

Public Health England | October  2019 |UK alcohol clinical guidelines development begins

Public Health England  (PHE)  is working in partnership with the Department of Health and Social Care (DHSC) and the Scottish, Welsh and Northern Ireland governments, to produce UK-wide clinical guidelines for alcohol treatment to provide support for alcohol treatment practice.

There is currently no equivalent for alcohol to the UK drug misuse treatment guidelines (the ‘orange book’), which has been vital in establishing and maintaining good practice for drug treatment. The proposed alcohol treatment guidelines will fill this gap.

The main aim of the guidelines is to develop a clear consensus on good practice and help services to implement interventions for alcohol use disorders that are recommended by the National Institute for Health and Care Excellence (NICE). The aim is also to promote and support consistent good practice and improve the quality of service provision, resulting in better outcomes.

The project begins in November with the guidelines anticipated in early 2020.

Further details from the Department of Health and Social Care

UK alcohol clinical guidelines development begins

NICE: Alcohol interventions in secondary and further education

NICE | August 2019| Alcohol interventions in secondary and further education NICE guideline [NG135]

NICE have issued a new guideline which covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.

Read the guidance in full from NICE

Smoking, Drinking and Drug Use among Young People in England

NHS Digital | August 2019 | Smoking, Drinking and Drug Use among Young People in England

smoking yp

The Office for National Statistics  and NHS Digital have released the findings of the biennial survey of secondary school pupils in England in years 7 to 11 (mostly aged 11 to 15), focusing on smoking, drinking and drug use. The survey covers a range of topics including prevalence, habits, attitudes, and for the first time in 2018, wellbeing.

A summary report showing key findings, excel tables with more detailed outcomes, technical appendices and a data quality statement (Source: NHS Digital).

Full details are available from NHS Digital



[NICE Guideline update] Alcohol-use disorders: prevention

NICE | August 2019| Alcohol-use disorders: prevention

 NICE has published its surveillance decision and will update the guideline on alcohol-use disorders: prevention (NICE guideline PH24). Areas indicated for update are:

  • screening children and young people aged 10 to 15 years, and 16 and 17 years (recommendations 6 and 7)
  • brief advice and extended brief interventions in adults (recommendations 10 and 11).

Full details are available from NICE 

Healthcare leaders call on Government to prioritise alcohol prevention

The British Medical Association (BMA) and other leading healthcare organisations have written to the public health minister expressing their concerns over the impact that alcohol is having on the nation’s health urging the Government to prioritise a new alcohol strategy.

In the letter to Seema Kennedy MP, the BMA board of science chair, Professor Dame Parveen Kumar, along with the chairs of the Royal Colleges, warn of the ‘escalating risk to public health’.

The letter warns that despite recent strategies for obesity and tobacco, there has been a “lack of strategic focus” and asks that the Government prioritises alcohol in the same manner and works to urgently produce an updated and ambitious national alcohol strategy.

BMJ Open study: Alcohol consumption as a modifiable risk factor for breast cancer

Sinclair JMcCann MSheldon E, et al | 2019| The acceptability of addressing alcohol consumption as a modifiable risk factor for breast cancer: a mixed method study within breast screening services and symptomatic breast clinics| 

New research now published in the BMJ Open, recruited women attending NHS Breast Screening Programme (NHSBSP) mammograms, symptomatic breast clinics and healthcare professionals in these settings, the study used a mixed-methods approach- interviews and surveys- to ask women about their knowledge and attitudes towards alcohol as a risk factor for breast cancer.
The findings highlight that only 20 per cent of women in the sample recognised alcohol as a breast cancer risk factor, almost half of NHS staff identified it as a risk factor. 

Objectives Potentially modifiable risk factors account for approximately 23% of breast cancers, with obesity and alcohol being the two greatest. Breast screening and symptomatic clinical attendances provide opportunities (‘teachable moments’) to link health promotion and breast cancer-prevention advice within established clinical pathways. This study explored knowledge and attitudes towards alcohol as a risk factor for breast cancer, and potential challenges inherent in incorporating advice about alcohol health risks into breast clinics and screening appointments.

Design A mixed-method study including a survey on risk factors for breast cancer and understanding of alcohol content. Survey results were explored in a series of five focus groups with women and eight semi-structured interviews with health professionals.

Setting Women attending NHS Breast Screening Programme (NHSBSP) mammograms, symptomatic breast clinics and healthcare professionals in those settings.

Participants 205 women were recruited (102 NHSBSP attenders and 103 symptomatic breast clinic attenders) and 33 NHS Staff.

Results Alcohol was identified as a breast cancer risk factor by 40/205 (19.5%) of attenders and 16/33 (48.5%) of staff. Overall 66.5% of attenders drank alcohol, and 56.6% could not estimate correctly the alcohol content of any of four commonly consumed alcoholic drinks. All women agreed that including a prevention-focussed intervention would not reduce the likelihood of their attendance at screening mammograms or breast clinics. Qualitative data highlighted concerns in both women and staff of how to talk about alcohol and risk factors for breast cancer in a non-stigmatising way, as well as ambivalence from specialist staff as to their role in health promotion.

Conclusions Levels of alcohol health literacy and numeracy were low. Adding prevention interventions to screening and/or symptomatic clinics appears acceptable to attendees, highlighting the potential for using these opportunities as ‘teachable moments’. However, there are substantial cultural and systemic challenges to overcome if this is to be implemented successfully.

Read the article in full from the BMJ Open

In the news:

BBC News Women not aware enough of breast cancer link to alcohol

[NICE Consultation] Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence

NICE | April 2019 | Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence Clinical guideline [CG115]

The NICE consultation on Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence Clinical guideline [CG115] is open until 8 May 2019

Full details are available from NICE 

See also: [NICE Surveillance Consultation] Alcohol-use disorders: prevention