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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.
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.
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.
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.
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.
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.
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.
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