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Alcohol

Given the widespread nature of the effects of excessive alcohol consumption, it is inevitable that nurses working in any clinical or community setting will meet people whose drinking has led directly to health and social problems. Therefore, irrespective of the clinical area in which we work, all nurses, with the possible exception of theatre nurses, have a potential role in both the prevention and management of problem drinking.

The majority of dependent problem drinkers seek treatment within specialist services. Within such services the staff, often working within addiction teams, are experienced and well-trained in detoxification, individual and group interventions. However there is now a convincing body of evidence of the prevalence of excessive alcohol consumption amongst general hospital in-patients who are admitted for treatment of conditions which are not primarily alcohol-related (SIGN 2003). Such interventions include the provision of simple advice aimed at giving information about health risks associated with heavy drinking and advice about how to reduce consumption to within sensible limits. Our interactions with patients and clients therefore give us opportunities to identify potential problem drinkers and to engage them in health promotion activities aimed at achieving a reduction in levels of consumption with the consequent prevention or reduction of alcohol problems.

Assessment

Accurate assessment is the key to detection of problem drinking. Without accurate assessment of alcohol consumption, we may not recognise problem drinkers, and opportunities for providing appropriate information may be missed. In addition, those individuals whose drinking places them at risk of developing withdrawal symptoms may not be detected until serious complications become evident.

As far as alcohol consumption and health are concerned, levels of risk can be classified as ‘Low risk’, ‘Hazardous’, and ‘Harmful’. The SEHD advice is that there is no significant health risk for men who drink no more that three or four units of alcohol a day, or for women who drink no more than two or three per day. The term ‘binge drinking’ is used to denote consuming more than twice the daily benchmarks, i.e. seven or more drinks on one occasion for women and, for men, nine or more drinks on one occasion. Hazardous drinking is defined as a pattern of drinking that carries with it a high risk of harm, whereas harmful drinkers are those who are already experiencing harm (World Health Organization 1994).

Most of us ask patients or clients about their alcohol use but this information is often collected in an ad hoc way that does not contribute effectively to developing appropriate action. Validated tools, however, that are specifically designed to aid clinical decision-making do exist, a selection of which have been posted on this site.

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