Evidence
Alert

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.  

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. 

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.

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

Conflicts of Interest

None declared.