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Alcohol

Up to 35% of all accident and emergency attendances and ambulance costs are estimated to be alcohol-related. Alcohol misuse costs the NHS in England up to £1.7 billion each year.

85. While prevention interventions will provide the best means of tackling many alcohol-related problems, there is a small but significant number of people, particularly men aged over 30, who develop much more serious alcohol-related dependence or health problems. Left untreated these can lead to long-term ill health, including stroke and cancer, and premature death as well as placing a heavy burden on the families of those involved.

86. Alcohol treatment is currently provided by GPs and specialist addiction services but most of the 500 alcohol treatment services in England are located within the voluntary sector. These are usually funded by PCTs or local authorities and receive referrals from GPs or other NHS specialists.

87. The cross-government Alcohol Harm Reduction Strategy for England recognised that the provision of alcohol treatment in England was patchy and that some areas were unable to provide access to the full range of support needed.

By April 2005:

  • the DH will publish national and local audits of the demand for and provision of alcohol treatment.

By May 2005:

  • the National Treatment Agency (NTA) will publish 'Models of Care' guidance on the organisation of alcohol treatment and a road map detailing how to put this into practice.

88. These will lay the foundation for the future development of alcohol treatment within England. However, it is already clear that in order to provide high-quality, local services suited to the needs of service users, their families and carers, many areas will need long-term improvements in their current provision. To support this we will build on the commitments within the Alcohol Harm Reduction Strategy for England through:

  • guidance and training to ensure all health professionals are able to identify alcohol problems early;
  • piloting approaches to targeted screening and brief intervention in both primary care and hospital settings, including A&E departments;
  • similar initiatives in criminal justice settings with the aim of reducing repeat of fending, by ensuring that alcohol treatment needs are met alongside drug misuse treatment needs;
  • developing a programme for improvement for alcohol treatment services, based on the findings of an audit of demand for and provision of alcohol treatment in England and the Models of Care Framework for alcohol treatment.

These initiatives will be supported, from April 2006, through additional funding provided through the Pooled Treatment Budget for Substance Misuse.

Case study

A team at the Accident and Emergency Department of St Mary's Hospital, London have developed and validated the 'one-minute Paddington Alcohol Test' (PAT), a short screening questionnaire that detects those drinking excessive alcohol. 

By auditing the use of PAT and selectively screening those who present with the 10 conditions most often associated with alcohol misuse, the department was able to increase the rate of detection of alcohol misuse fourfold. 

People found to be consuming excessive alcohol are then offered an appointment with an alcohol health worker. Two-thirds of those offered an appointment accept the offer. If the appointment is on the same day that the person attends the A&E, 65% attend. In a randomised controlled trial examining the effects of referral, it was shown that those offered an appointment drank less alcohol during the following year than those who were not. People offered an appointment were also less likely to re-attend the department: for every two patients who accepted an offer of brief advice, there was one less re-attendance to the department during the following year. 

Screening and referral for brief intervention for alcohol misuse in A&E provides an opportunity to help patients develop insight into the consequences of their drinking and promote improved health, thereby making best use of 'the teachable moment', i.e. the desire not to make themselves vulnerable again (reference - Crawford et al, The Lancet, 2004: 364: 1334-9). 

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