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Frontline NHS staff should be trained to tackle alcohol misuse

September 08, 2006

Large amounts of money and resources would be saved if all frontline NHS staff had basic knowledge about the social and physical ill effects of alcohol misuse, say doctors in this week's BMJ.

In 2004 in England 38% of men and 16% of women aged 16-64 had an alcohol use disorder (26% overall), equivalent to around 8.2 million people.

About £217m is currently spent on specialist alcohol treatment, compared with the £20bn estimated cost of alcohol misuse. The government recently announced that £3.2m was to be made available for new initiatives for people who may be damaging themselves with alcohol. But will this new money be used wisely, ask Robin Touquet and Alex Paton?

Most conurbations in England have one or more specialist alcohol units, which are usually run by psychiatrists and largely deal with complex problems. These are controlled by mental health trusts, which are separated administratively from acute hospital trusts, so services tend to be fragmented.

In many areas voluntary agencies also provide a local service for people with alcohol problems, funded from various sources such as the local authority, primary care trusts, and charitable foundations. NHS services now rely solely on funds from primary care trusts.

Funding by primary care trusts for alcohol services could be well used in hospital emergency departments, where nearly a third of overall attendances are alcohol related, and more than two thirds may be so after midnight.

Research carried out by the emergency department team at St Mary's Hospital London has shown that routine clinical staff can be trained to detect potential alcohol problems and to offer brief advice, with support from an alcohol health worker in the hospital. This approach is cost effective.

Studies have also shown that alcohol problems are underdetected in general practice, and the authors suggest closer liaison between general practitioners and local voluntary alcohol agencies, wider availability of alcohol workers, and alcohol clinics in general practices.

They also suggest that all general hospitals should have a senior consultant with an interest in alcohol misuse. Yet a recent review found that only 21 acute hospital trusts in England had an alcohol health worker.

If all frontline staff had basic knowledge about the social and physical ill effects of and the detection of alcohol misuse, and the benefits of brief advice and liaison with alcohol health workers, problems would be tackled far earlier - often preventing the development of dependence - and large amounts of money would be saved, they write. The new two year foundation training for junior doctors offers an important opportunity to develop such knowledge.

BMJ-British Medical Journal