Patients face quiz over drink habits

A MULTIMILLION pound scheme has been launched to halt serious alcohol problems before they take hold in drinkers who are unaware they are exceeding safe limits.

Doctors, nurses and dentists across Scotland will be trained to quiz thousands of patients about their drinking habits and offer counselling to those breaching safe levels.

Women who regularly drink more than three units a day and men who drink more than five will be subjected to a 'brief intervention', where NHS staff will warn them about the dangers of alcohol, ask them to cut back on their drinking and tell them to return for a follow-up appointment.

Despite repeated attempts to highlight safe levels of alcohol, in Scotland there is still confusion about how much it is safe to drink. High on the list of people health officials want to reach are those who drink at home in the evening, after work and at weekends. They are unwittingly putting themselves at risk of a range of health problems, including high blood pressure and liver disease.

The move, part of an £85m three-year Scottish Government alcohol strategy, will see around one in six Scots 'screened' for their drinking habits during routine appointments with GPs, dentists and nurses.

Health boards have a target of offering up to 150,000 Scots identified as 'hazardous drinkers' help ranging from leaflets and guidance to extensive counselling.

Despite it emerging last year that guidelines on safe alcohol consumption are not based on clear evidence, the strategy is using the 1987 figures because no credible alternative has been provided by researchers.

For women, a trigger point for counselling will be admitting regularly drinking three units or more a day – which is the equivalent of any more than two 125ml glasses or one 250ml glass of wine.

For men a trigger point would be five units – any more than half a bottle of wine or two pints of lager. Other triggers would be admitting weekly 'binges' of more than six units in one evening for women and eight units for men.

Last night, health campaigners welcomed the move, but critics questioned whether it would work in practice and reiterated that moderate drinking was part of a healthy lifestyle.

A raft of initiatives have been developed to target potential danger drinkers. They include:

• Training NHS staff to carry out 'brief interventions' during which they ask patients about drinking and challenge them to change bad habits;

• Paying GPs up to £200 a patient to carry out brief interventions and monitor progress;

• Training NHS dentists to quiz patients on their alcohol consumption and monitor their progress at six-monthly check-ups or refer them to counselling services via GPs;

• Asking NHS 24 callers phoning about problems such as stomach pains or indigestion about their drinking and referring them for help to specialist telephone nurses or their GP.

The move is being organised by the Scottish Government's public health agency, NHS Health Scotland.

George Howie, its alcohol and drugs programme manager, yesterday said: "A number of healthcare settings offer a really good opportunity to identify people at a relatively early stage in their alcohol problem. It can be done in a planned way, such as routine screening, or from an opportunistic way by working with clues from what patients say that suggest there is a problem.

"Underlying problems can manifest themselves because of drinking, such as high blood pressure, stomach problems, infertility, depression and anxiety. These might help the health professional to work with the patient to make the link with their drinking. The health professional can take patients through their pattern of consumption and help them."

He added: "It's down to the individual to choose whether they need to change. But the earlier we can intervene, the better the chances of recovery."

A recent trial of the scheme in the Dumfries and Galloway area found it to be a success for some drinkers. A total of 550 patients were randomly screened at GP practices. One in five was found to be a problem drinker. Of these, nearly 60% returned three months later and had reduced their alcohol consumption, with 46% showing a significant improvement in the liver-function test.

Health boards are expected to meet targets in line with other responsibilities and will be accountable to the Scottish Government if they fail.

Christine Goodall, a clinical lecturer in oral surgery at Glasgow University Dental School, is organising training for NHS dentists and says issues such as gum disease and broken teeth can be linked to alcohol problems. She said: "Dentists quite often get left out in terms of health promotion, but there's a lot of them out there seeing patients every day."

Yesterday, the scheme was welcomed by experts and campaigners. Dr Dean Marshall, chairman of the Scottish GP committee of the British Medical Association, said it could prove effective provided funding is channelled properly.

"Primary care provides a useful opportunity for brief interventions, but it's essential that systems are developed to encourage this on a regular basis with funding, resources and comprehensive training and guidance on screening and delivery," he said.

Some have criticised the safe limit guidelines. Richard Smith, a member of the Royal College of Physicians working party that produced the guidelines in 1987, said the recommendation was prompted by "a feeling that you had to say something".

However, Barbara O'Donnell, director of services for Alcohol Focus Scotland said: "The cost of alcohol problems in Scotland is £2.25bn, the problems ranging from issues of health, employment, relationships and family life to legal problems."

Jonathan Mail, spokesman for the Campaign for Real Ale, said home drinking was being fuelled by cheap deals at off-licences. He said:

"Camra believes that the drinking of good-quality real ale with friends in a well-run community pub encourages sensible drinking. It is deep discounting in off-licenses and supermarkets that is driving heavy drinking."

Wine expert Ian McNeill, of the Wine Experience, said: "I think it is good to be challenged on your drinking now and again and a verbal reminder does no harm."

A Scottish Government spokesman said: "Far too many Scots are drinking more than the sensible drinking guidelines and alcohol-related health problems are spiralling as a result.

"The Scottish Government believes this is a problem we must get to grips with as a matter of urgency."

'It's hard to know how many glasses of wine you are supposed to have as the size varies so much'

In a snapshot taken by Scotland on Sunday yesterday it was apparent that many drinkers are unaware of the safe alcohol limits outlined by the Government

Susan Walker, 45, a receptionist from Edinburgh, was way out.

She said: "I think it's about 14 units per day, but I'm not really sure at all.

"I guess that means four glasses of wine, but that seems rather a lot."

Sales assistant Johnny Dunn, 24, also had to guess: "I'm sure this has cropped up in the news recently. I'm going to say five units. Actually, make that three, I'll be on the safe side.

"I think that's probably between two and four pints."

Roy Lorimer, 29, a scaffolder from Edinburgh, was doubtful. "We Scots drink quite a lot so I think it must be about six units per day. That's about three pints, or two and a half pints of Stella. But I don't think people pay much attention to these kind of warnings anyway."

Nicola Ferguson, 34, a learning and development consultant from Aberdeen, guessed correctly.

"For a woman I think it's about three or four units per day, though perhaps it could be less. I guess about a glass and a half of wine every evening."

Pam Jenkinson, 48, a pensions manager from Edinburgh, said it was difficult to know what was safe. "I'm going to guess it's about three units or something. It's hard to know how many glasses of wine you're supposed to have as the size varies so much. But it's probably around two standard glasses of wine. I think the Government has done well to put the drink and drive message across to the public but has definitely missed out on the health aspect."