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Calling time on our drink problem…

A recent European survey into Ireland's drinking culture shows that when it comes to alcohol, the Irish are in a league of their own. We drink far more than our European counterparts and we have more problems per drinker here. In fact alcohol-related problems now cost Irish society around €2.4 billion per year.

It is an issue which the Government has attempted to tackle through its national awareness campaign, 'Think before you drink - less is more'. It has also recently introduced strict new provisions in relation to pubs, including a ban on 'happy hour' promotions and strict fines for publicans who sell alcohol to people who are already drunk.

Taking into account the results of the European survey, which compared Ireland's drinking habits with six other countries, including Britain and Germany, these new provisions are certainly needed. Irish people now drink 12.1 litres of pure alcohol each year, which is almost twice the level reported in most of the six countries surveyed, the only exception being Britain, with nine litres.

Binge drinking the norm

Furthermore, a drinking occasion in Ireland involves binge drinking more often than in any of the other countries surveyed, to the extent that binge drinking is now 'the norm' for Irish men and occurs in about one-third of the drinking occasions of women.

As a result of this high alcohol consumption, there are a significant number of people with alcohol dependency problems - some may have already crossed the blurry line into alcoholism and depressive illness, while others are at the borderline, 'hazardous' drinkers who have a chance to avoid dependence if they are caught in time.

Unfortunately a large number of people with alcohol problems are slipping through the net and failing to receive the help they need. According to the Eastern Regional Health Authority, there are many opportunities to identify alcohol problems within various healthcare areas, however these 'are not being realised to their full potential'. There are several reasons for this including the hidden, secretive nature of addiction and the fact that many health professionals are simply so busy, they may not have time to take a detailed history of a patient.

How family doctors can help

However a recent pilot study by the Irish College of General Practitioners found that with better training and resources, GPs could help a significant number of patients with alcohol problems. GPs as primary healthcare providers are obviously in an ideal position to spot potential or already existent problems.

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According to Rolande Anderson, project director of the ICGP's programme, 'Helping patients with alcohol problems', which carried out the study, the problem of alcohol abuse in Ireland has been described in detail, yet little concrete has been done to actually help patients.

"This study is the first attempt to learn how to tackle the problem in primary care on a national level. Alcohol problems have traditionally been badly neglected in primary care due to busy surgeries and lack of training. The study demonstrates however that GPs and their staff can be effective with a minimum of training and a lot of support", he explained.

Results

Ten GP surgeries throughout the country took part in the study - one practice in each health board region. Altogether 2,290 patients were randomly screened - they filled out a questionnaire and provided details of their weekly alcohol consumption.

For the purpose of the study, the AUDIT (alcohol use disorders identification test) questionnaire was used, as this has been found to be the best screening tool within a GP setting. The GP's own clinical judgement was also taken into account. Each patient was then allocated to one of three risk categories:

-Green = low risk.

-Orange = hazardous.

-Red = harmful/dependent.

At this point if necessary, a 'brief intervention' took place. This intervention ranged from simple advice to a referral to a specialist. Those in the orange and red categories were followed up three months later to see if this intervention had worked.

In each surgery, key staff were trained in how to intervene effectively with patients.

The study found that among those randomly screened, 68% were low risk, while 13% were teetotal or in recovery from alcohol addiction. However 16% were in the hazardous category, while a further 3% were in the harmful/dependent category. This means that around one in five patients had a problem with alcohol.

Of those screened, 442 patients were deemed to require follow-up. Around two-thirds (298) of these did attend this follow up. Of these 298 patients, 30% had moved to the low risk category after just three months, 'a small but significant step', according to Mr Anderson.

In line with recent findings that binge drinking is more common among younger adults, the majority of patients who required follow-up were under the age of 30.

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The study also found that patients do not object to being asked about their drinking. In fact, they welcome the help delivered in a sensitive style.

"This service overall is very compassionate, supportive and cost effective, reducing demand on hospital beds, medical certificates and other services", said alcohol counsellor, Donal Kiernan, who was assigned to one of the surgeries involved in the study.

Counsellors

The surgery located in Baltinglass in Co Wicklow was the only participating surgery to have an alcohol counsellor on site, however this was seen as particularly beneficial, as it made a big difference to the numbers of patients who were screened and treated successfully.

"The open emphatic approach of the counsellor is almost certainly a factor which increases patient compliance", said Dr Cait Clerkin, one of two GPs who run the practice.

In fact the only complaint in relation to the alcohol counsellor was that the allotted time for counselling was just six hours per week, which was considered totally insufficient.

Mr Anderson emphasised that the study was small and therefore gave 'just a snapshot' of the overall picture, however for those who have been helped and their families, the benefits are considerable.

Apart from the benefits of having a counsellor on site, he said he would also like to see increased development of the role of the GP practice nurse, as well as the publication of more dedicated booklets for GPs and patients on the topic of alcohol.

"There is no answer in the bottom of a bottle or glass, only the illusion of peace. What this pilot study has shown is the need for such a service. It needs to continue here and be replicated elsewhere", Mr Kiernan added.

Countermeasures

The Irish Government’s Strategic Task Force on Alcohol has made a number of recommendations to deal with what is something of a national crisis. It argued for more regulations on the availability of alcohol, better drink-driving countermeasures, increased taxation, restricting alcohol promotions, better community action, education and promoting alcohol free activities. Some of these measures are more effective than others but if they are all applied, then the impact should be significant.

Recently the Irish Medical Organisation called for a complete ban on the sale of designer drinks related to underage consumption and better research on young people and alcohol. It also suggested that the blood alcohol level permitted for L drivers be reduced to zero.

Alcohol has and remains a major part of Irish culture. We are only now recognising how it can lead to serious health problems including premature death and disease.

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Last Reviewed: 14th November 2003



  Jim(Jimgclarke)  Posted: 15/11/2003 09:28
An excellent, cogent and valuable contribution to the debate on this country's problem drinking. Well done, Deborah.
 
  Thomas(Hepatitus)  Posted: 26/11/2003 04:08
Hi There,I Spent 3 days in Hosp. From 17-11-03 2 20-11-03 in C.U.H Treated for liver biop. Was very scared to see 2 patients create uproar over alcohel (eg Needed Drink) Left CUH Went 2 Pub Came Back 3 Hours Later well drunk . What a health service , ? Thank U TOM c
 
  Anonymous   Posted: 10/03/2004 12:26
I think we need to analyse why our attitude to drink as a nation is so much less mature than other countries of europe
 
  Anonymous   Posted: 10/03/2004 14:37
I think there should be more research carried out to assess why the level of alcohol consumption in this country has risen so much in recent years. Previous studies showed Ireland behind other European nations in terms of alcohol consumption per capita. I'm not suggesting that there wasn't a problem before, but it just seems to be getting worse. Anecdotally, I know more and more people who systematically go out every weekend with the specific intention of getting drunk (to put it mildly!) Thankfully I have a sensible attitude to drink, but increasingly I seem to be in a minority among my peers.
 
  Anonymous   Posted: 10/03/2004 15:43
These are frightening statistics and something that we now need to take seriously and actively confront. The recent tragic events at Club Annabel can be safely assumed to be partly (or largely?) as a result of excessive drinking, we need to take stock and take measures to protect our young people and offer alternatives to our alcohol culture. Does it start in childhood with children learning to drink from their parents or is it "Irish Culture", i.e. craic agus ruille buille?? LK, 29
 
  P(PRafter)  Posted: 10/03/2004 19:46
We certainly seem to have a liking for drugs and since alcohol is the only drug permitted, indeed promoted, by the state, we're stuck with it. Cannabis is a much safer drug, all round, but there's a problem; it's foreign, used by people with totally different cultures(and colour)and so is resisted by our generally latent xenophobia. Thank you.
 
  liam(mail4liam)  Posted: 10/03/2004 23:44
we as a nation are a fun loving lot. we work, hard , we live life to the full, we drink to forget that every sucsessive goverment are screwing us to the hilt.and now everyone else are screwing us since the euro came into existence.so stuff the eu surveys and everyone east of the irish sea. they know no craic and they will all die standing up.they are all so straight faced. and so oooo boring .
 
  Anonymous   Posted: 11/03/2004 00:20
I have just given up drink for a month. The first time since i was 16, and its not easy. There are not many alternatives to the pub on the weekend, videos and cinema can only be done so much.
 
  P(PRafter)  Posted: 11/03/2004 18:23
If the views expressed by Liam, above, are widely shared, then we're all in deep do-do. Thank you.
 
  liam(mail4liam)  Posted: 15/03/2004 00:17
i welcome the views of p rafter. and i hope that this person has a happy and fulfilled st. patricks, day, drink and bee merry for tomorrow may never come.
 
  P(PRafter)  Posted: 16/03/2004 18:41
Thanks for that Liam, and the same to you; as for the drink, my attitude to it changed years ago. I hope yours will too, in time. Thank you.
 
  Anonymous   Posted: 17/03/2004 00:12
Drink in Ireland is such a sacred cow that it's difficult to challenge without being labelled a bore or an extremist. People can stay drinking to a dangerous degree and that's ok. Anything but give it up entirely; so much so that you're only considered an alcoholic after you stop drinking.Once you stay drinking, you don't upset anyone's comfort level, even if you're drinking yourself to death.I have seen friends and family destroy themselves with drink and that has been preferable to their families than for them to enter treatment and get sober. I'm sure their families would find it hard to admit to this truth. People who choose not to drink are viewed with suspicion in Ireland because so much is invested in the drinking culture being the norm. I have friends who would consider it a waste of a night to go to see a play or a good film, and they're not seen as big drinkers. Yet, their movements revolve around protecting their drinking time and making sure nothing interferes with this. This kind of behaviour in another country would be viewed as obsessive in terms of alcohol, but here it's just normal.
 
  Patricia(GMC11099)  Posted: 26/06/2004 14:29
Liam: There is nothing "fun loving" or "fun" about vomiting your guts out on street corners, and looking like a pig (and maybe getting killed, or killing other people in brawls) because of excessive drink. I don't see anything "fun-loving" about the Irish. Everyone is aggressive, foul-mouthed, irritable, badly dressed (the majority), not too great on the personal cleanliness......I could go on. I am Irish, I might add, though I live abroad (yes, on that land mass east of our befuddled island), and I do like a social drink myself now and then. But no one has to be blind drunk to have "craic". You can have that (presuming you do not have some psychiatric condition) even if you are cold sober. I think you need to see a psych, Liam. You have serious problems.
 
  Anonymous   Posted: 30/06/2004 08:57
Patricia, if you think everyone in Ireland is aggressive, foul-mouthed, irritable, badly dressed and not too great on the personal cleanliness it must be a long long time indeed since you were here. 50 or 60 years perhaps. The Ireland that you know has changed very much in the meantime. In a great many respects except its attitude to alcohol - in this, we, as a nation have yet to mature
 
  Patricia(GMC11099)  Posted: 03/07/2004 16:27
Hello Anonymous (30.6.04). Indeed no. I was last there a few months back. I wish I could say otherwise, I really do. And of course, there are always the honourable exceptions! But other Irish people (and also outsiders) are saying the same as I do. I am only stating what I see, (not what I think)and what I see is not very nice at all. People are soooooo aggressive (everywhere), on the roads, covertly aggressive in the services industries, obviously unhappy with their lot in life. It is not just with regard to alcohol that people have to "mature". Just take a look at the litter problem. Ireland is a truly beautiful country, but its people have no respect for that beauty. You come across a lovely spot, say beside a lake, and what do you see: completely marred by a burst-open bag of refuse. Who doesn't use the odd swearword from time to time, but......is it necessary to have entire conversations, all the time, with entire sentences consisting of little else but swearwords. I tend to observe and listen a lot when I am out and about. And, I can only, sadly, stand by what I said in my first post. All the best
 
  Anonymous   Posted: 05/07/2004 07:59
Patricia, I would be intrigued as to what part of Ireland you last visited - mainly so I could aviod all these dirty aggresive, foul-mouthes badly dressed people.
 
  Patricia(GMC11099)  Posted: 19/07/2004 17:12
Regrettably, the entire country, Anonymous. There is no point in being sarcastic with me. (lowest form of wit,as well) and aggressive, I might add. Can you not just discuss the matter with me without becoming sarcastic? I could not have seen Ireland 50 0r 60 years ago for the simple reason that I have not reached that age just yet! I am not alone in what I say. I just wish I could say otherwise, I really do. Look at the state of our roadsides, dirt, empty cans, bottles, trash of all kinds. It is not just me, as I said above in my post. Everyone in Ireland says the same thing to me. Listen to the radio, any time, and you will hear the same complaints as I am just (with great sadness) saying in my post on here. Walk down Grafton Street, O'Connell street, any street any city, and there is nothing but the f word in every sentence you hear uttered around you. best wishes P
 
  Anonymous   Posted: 20/07/2004 08:10
Yes, sarcasm is the lowest form of wit - but it's better than being dry! I agree, there is a lot of litter on the raodsides, streets and countryside. I'm not in the slightest bit aggressive I assure you. On the subject of the foul-mouthed, badly dressed, agressive people with poor hygene. I just want to know where to avoid them. But perhaps you caught us all on an off-day. In the lab where I work, there's very little swearing.
 
  pat(patphil)  Posted: 22/06/2005 22:09
Ireland has a "booze' problem ,always had and always will maybe it's in the genes.We are known for our charm and good manners at least in Canada.The lady Patricia sounds a bit bitter,which may reflect something else ,which is none of my business.Our history of oppression for so many years likely contributedto the problem, having to "touch the peek of t6he hat " to some terrible people in order to keep on the right sidehad to be very degrading. I love Ireland always have and always will,and it is delightful to msee her make her way so proudly.Up the Rebels
 
 
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