A new study highlighting the extent of alcohol problems amongst hospital patients has attracted media attention, indicating 1 in 5 are harmful drinkers and 1 in 10 are alcohol dependent.
The research used data from 124 studies covering 1.7 million patients in UK hospitals, indicating the level of harmful drinking amongst hospital patients is ten times higher than the general population, and eight times higher for alcohol dependence.
The study included only 'wholly attributable' alcohol conditions - those known to be as a result of alcohol like intoxication or alcohol-related liver disease - and excluded partially attributable conditions where alcohol tends to play a contributory role, such as high blood pressure. Harmful drinking and dependence in the study were based on meeting ICD-10 criteria covering 26 alcohol health or disease conditions.
The researchers note the high variation in study methodologies and findings, although prevalence appeared consistent over the 40 year period covered. Harmful use was found to be most prevalent in mental health in-patient units and least prevalent in general wards, whilst dependence was found to be most prevalent in A&E and least prevalent in general wards. The study excluded those using hospital based alcohol services like detoxes.
Older age was associated with lower levels of harmful drinking and dependence such that each 1-year increase in age above the age of 18 was linked with reduced prevalence. However, reasons for this are likely complex and any comparisons with the general population should be considered with caution given limitations to the data.
Although population prevalence of harmful drinking and dependence is been higher in younger groups, consumption trends appear to have narrowed this gap. Meanwhile, alcohol-related hospital admissions, at least under the broad measure, have continued to rise, hitting a peak of 1.2 million in 2018, though the more specific 'narrow' measure appears to have stabilised.
Hospitals - a key setting for alcohol interventions?
Calls for hospitals as a key setting for alcohol interventions and support have been a central alcohol policy theme over recent years. Investment in Alcohol Care Teams (ACTs) has increased, in contrast to shrinking community based services and declines in treatment numbers as public health cuts continue to bite.
Whilst a 2014 PHE report identified that many hospitals had at least some form of specialist alcohol provision, MP Jon Ashworth recently pledged Labour would fund an ACT in every district hospital at a cost of £13.5 million, resulting in savings of £40 million to the NHS. Figures were reported suggesting that at least 41 English hospitals do not currently have an alcohol care team in place. Earlier this year the Government's new NHS Long Term Plan (LTP) included a commitment to see ACTs in hospitals with the highest rate of alcohol dependence-related admissions, although the plan does not appear to equate to any material funding.
ACTs however largely involve support for alcohol-dependent patients, including detoxes and linking into community services upon discharge. Whilst many ACTs have supported efforts to embed brief interventions, a CQUIN has been established by PHE to incentivise hospitals to deliver alcohol 'Identification & Brief Advice' (IBA) to eighty per cent of patients admitted as a hospital inpatient for one night or more.
As such, hospitals may be the one setting where resources for alcohol interventions and support have been increasing. The latest study evidently supports the case for such investment by identifying the scale of the problem in hospitals in particular. Calls will no doubt continue for action over the declining resources for community settings, and the need for population levels measures aimed to help prevent the extent of such problems in the first case.
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