GPs no Longer in the Dark on Alcohol Issues

Prior to the commencement of the Helping Patients with Alcohol Problems project, the subjects of alcohol problems and management of patients with these problems in primary care had been largely neglected.

GPs and primary staff in general felt unskilled and were confused about their role. The initial plan was to raise awareness in general practice about the issue and to back practices up with skills and educational and/or training resources and aids.

The project has had three distinct phases to date:

• 2000-2003: Merck Pharmaceuticals funds the project for 39 months.
• 2003-2006: The Department of Health and Children funded the project.
• 2007: current phase, funded by the HSE.

Ignorance, Excuses and Lack of Training

Before the programme commenced, ignorance about alcohol was rampant amongst many doctors and patients. Some GPs tended to equate alcohol problems with 'alcoholism', not realising that there is in fact a range of alcohol problems. Just like patients in the throes of alcohol dependence, all sorts of 'plausible excuses' are offered by some practitioners for the lack of attention to alcohol problems: too busy; nowhere to send patients; no hope of change; insurance concerns, etc.

The simple truth is that GPs and other primary care staff can make an enormous difference to the health and wellbeing of patients and their families by simply asking about alcohol problems and by offering ongoing support and help. Relatively basic training and other back-up resources are all that is required. The earlier alcohol interventions take place the better the outcome.

Achievements

Much has been achieved by the alcohol project team at the College. The specifics are hard to quantify. We have been shouting about alcohol problems from the rooftops and there is definitely an epidemic of alcohol problems out there. ICGP is now regularly consulted by the media about all aspects of alcohol.

There are important political aspects too. The vested interests attack those of us who care about this problem. 'Counter-advertising', that sometimes resembles ordinary advertising, is common. In many cases, the public is at a loss to know where the messages are coming from. For example, the current 'Drinkaware' media campaign is actually made by Mature Enjoyment of Alcohol in Society (MEAS), which is funded by the drinks industry. I call this mass-deception and describe it as 'message laundering'.

With such confusing information being promulgated, and ignorance amongst patients, primary care staff have an important role to educate the public about all aspects of alcohol, and of course, to treat patients as necessary and appropriate. Every GP has several tragic stories to tell regarding their patients and alcohol. Alcohol is implicated in so many health consultations. A few examples:

• General health: blood pressure, headaches, tiredness, vague symptoms, infections, liver problems, gout, heart problems, skin disorders, weight loss/gain, etc.
• Sexual health: pregnancy and fertility problems, foetal alcohol syndrome, STIs, morning after pills, assaults and rape.
• Occupational health: absenteeism, 'presenteeism', accidents, incidents, fraud, etc.
• Mental health; depression, suicide, anxiety, phobias, confusion, mood swings and insomnia.
• Other: marital problems, domestic violence, child sexual abuse, etc.

The above list is of course not comprehensive, and it must be understood that family members of patients with alcohol problems present with all of the above and more besides.

Through the project, the College has successfully conducted two major studies; the Alcohol Aware Practice Pilot Study, 2002-2003, (nationwide initiative) and the Alcohol Aware Practice Service Initiative, 2005-2006. This involved the placement of alcohol counsellors within primary care sites in the eastern region and worked well.

The studies reveal that at least one-third of patients in primary care have some form of alcohol problem. One-third of these patients with alcohol problems does extremely well, and one-third make 'some improvement' with intervention at primary care level. The counsellor aspect of the studies shows that if resources are provided, GPs will find and treat patients with alcohol problems. Imagine if the above results could be replicated across the country? Since the start of the project, numerous articles have been written, lectures and courses delivered and interviews given.

The College is a partner in the EU Phepa (Primary Health Care European Project on Alcohol), which has an Irish team made up of experts from different fields. The module Alcohol and Growing Older was published in 2005 and is available to GPs and an impact guidelines document on alcohol is almost ready for publication by the Quality in Practice committee.

This is only a small sample of the highlights. The biggest achievement of the project is that individual GPs have been empowered to treat patients and to speak out on this subject.

'Lots Done, More to Do!'

Hopefully the project can continue going from strength to strength over the next few years. The key targets now are:

• To develop software to help with screening and treatment of patients for all primary care staff.
• To produce an 'oven-ready' training manual/resource pack for the GP training schemes.
• To push alcohol further up the CME agenda; to develop more modules; to provide more training courses; and
• To push for more service initiatives availing of counsellors on site.

As always, feedback is welcome and I would like to take this opportunity to thank all of those who have helped to support the project over the last seven years; all of the funding agencies (including the HSE for their help with the two main studies), the reference groups, individual doctors and other primary care staff and international colleagues as well as the Irish Phepa team, but most especially my colleagues within the ICGP who have always been a tower of strength and support.

Rolande Anderson is Director of the ICGP Helping Patients with Alcohol Problems Project