Evidence
Alert

Alcohol advice needs to address how and why people drink, not just how much

GPs can help patients reduce their drinking by providing brief advice during a routine appointment. New research found that discussions on alcohol are most effective when they reflect how and why people drink, rather than simply how much.

Most 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. The new study found that people would welcome the advice, but it also calls for GPs to receive training to help ensure discussions are effective.

Researchers interviewed 22 adults who had all received alcohol advice from a doctor or nurse in primary care. Participants believed the recommended limit was flexible, and would depend on someone's size or gender. They thought that alcohol was harmful when people had emotional issues with it, and 'needed' to drink. They were less aware of the risks to physical health from heavy drinking, such as cancer or heart disease

There may be a need for more relevant public health campaigns to raise awareness of the long-term consequences of heavy drinking, the researchers say. 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. Some 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. 

Harmful drinking was thought to be less about the quantity consumed and more about a person’s emotional relationship with alcohol. Patients associated problem drinking with ‘needing’ to drink and drinking to become ‘drunk’. 

Tips and techniques to reduce drinking were more likely to come from friends and family, rather than from medical advice. The researchers suggest that GPs could build on the strategies people are already using for limiting their drinking.

Primary care nurses and GPs were seen as trustworthy and objective. Patients did not mind being asked about their alcohol consumption by a nurse or GP, and thought it could be valuable.     

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. Lead author 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. 

You may be interested to read

The full paper: O’Donnell A, and others. Patients’ experiences of alcohol screening and advice in primary care: a qualitative study. BMC Family Practice 2020;21:68

Kaner EFS, and others. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev. 2018;28:301-23

O’Donnell A, and others. Beliefs and attitudes about addressing alcohol consumption in health care: a population survey in England. BMC Public Health 2018;18:391 

Khadjesari Z, and others. ‘I’m not a real boozer’: a qualitative study of primary care patients’ views on drinking and its consequences, Journal of Public Health, 2019;41:e185–e191. 

 

Funding: Study author Amy O’Donnell was funded by an NIHR School for Primary Care Research Fellowship. 

Conflicts of Interest: The authors declare no conflicts of interest.

Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Commentaries

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

Researcher

The learnings from this paper provide clinicians with significant insights into how to tailor alcohol advice for their patients. The findings derive from a qualitative study with a necessarily small sample size and may therefore not encompass the globality of views held by the population. Nonetheless they provide important new perspectives and should be incorporated into GP training for giving alcohol advice.

Paul Wallace, emeritus David Cohen Professor of Primary Health Care, UCL