Beating the bottle

Nurses are ideally positioned to raise the subject of alcohol abuse with
their clients and, for those with a problem, even a brief intervention can make
all the difference.  By Kate Rouy

Within the context of the workplace, the problem of employee alcohol abuse
has long been a grey area for the occupational health adviser. Although many
organisations have a substance abuse policy in place, the onus remains very
much on the individual to come forward and admit to a problem with drinking.
The OH adviser can then react to the situation but the ability to tackle the
problem proactively remains limited.

However, according to a new charity, the Nursing Council on Alcohol, which
was launched at the end of 2000, the problem can be dealt with in a more
positive way, and nurses, in whatever area they are working, can take the lead.
Apparently, even a brief intervention offered by a nurse to a patient or client
experiencing problems with alcohol can make all the difference.

Research-led practice

According to the Nursing Council on Alcohol, taking a general approach to
the problems linked to alcohol use and its associated consequences, is
unrealistic. Instead, it says, research should lead the way. But there is no
point in funding research if the findings are not then transferred into
practice, and not just by the nurse working in the alcohol speciality but by
all nurses who hold a responsibility for the care of the individual.

"The aim of the organisation is to bring together a body of nurse
experts who can raise the profile of alcohol-related harm within the nursing
profession so that the potential of nurses to provide preventive advice and
appropriate intervention can be realised," says Secretary of the Council,
Dr Hazel Watson.

"When you think about it, nurses have far more opportunities than any
other member of the health care team to talk with patients.

"We therefore have huge potential to help people to think about what alcohol
is doing to their health. We know that at least 25 per cent of people who are
admitted to general hospitals are drinking in excess of the limits for sensible
drinking. Five per cent will already have had treatment for a primary alcohol
problem but the remaining 20 per cent are at risk of developing alcohol-related
problems and are therefore people for whom nurses can offer advice and
help," says Watson, senior lecturer in the Department of Nursing and
Community Health at Glasgow Caledonian University.

Nurses can make a difference

"There is strong evidence that we can make a difference for people who
are drinking at levels that exceed the recommended limits for sensible
drinking, in particular the 20 per cent of the general hospital inpatients at
risk of developing alcohol-related problems," she adds.

"In one study a nurse spent five to 10 minutes with each of these
patients giving them advice about the links between their drinking and any
health or social problems, teaching them how to calculate how much they were
drinking and giving information about how to cut down. One year later, the
patients reported a statistically highly significant reduction in the amount of
alcohol they drank. They were also found to have a significant reduction in the
number of alcohol-related health problems they experienced, and improvements in
liver function tests."

Watson says she would predict similar results in occupational health
settings, with a consequent impact on the burden of alcohol-related disability
in industry.

"In industry, many organisations have very good alcohol policies in
place," she says.

However, with a greater awareness of the alcohol issue by OH advisers, the
problem could be tackled more efficiently.

"OH advisers are very involved in general screening, which is an ideal
opportunity to raise awareness of alcohol limits," she says.

"We do not want to be prohibitive or to take a high moral stance, but
if alcohol assessments are undertaken within the context of a general lifestyle
assessment, it becomes more routine and acceptable.  The OH adviser has an excellent opportunity to meet people in
their ordinary everyday life, and we know that a brief intervention, given in a
non-judgemental way has a positive impact."

Kevin Cairns, OH adviser manager at Marks and Spencer is a member of the
steering committee of the Nursing Council on Alcohol and a keen supporter of
its initiatives.

"We have a company policy on substance abuse, by which we support
people who admit that they have a problem," he says.

"We will enter into a contract with them and will support them when
they enter a programme, be it detox or counselling. We would see them on a
regular basis and monitor their progress. But it has to be a two-way process.
We will support them as long as they do not backslide."

A problem must be admitted to

In the first instance, says Cairns, the employee has to admit to a problem
with alcohol, a difficult situation for anyone to confront. "If we in
occupational health can pick up a problem early, then it makes the situation
easier," he says.

"The way the business manages its attendance policy also helps with

However, he admits by the very nature of the problem, any help that can be
given is largely reactive rather than proactive.

Their OH department works in close co-operation with the company’s human
resources department in the tackling of substance abuse in the workplace, aided
by Marks and Spencer’s policy that has been in place for some time. Alcohol
addiction is treated in the same way as any other OH issue, as a health rather
than a disciplinary problem, with time off given as sickness absence for any
treatment that might be required.

Early intervention is the key

Hazel Watson, meanwhile, is convinced that intervention at the earliest
stage possible is the key to success in tackling this issue.

"If we can help people to think about their consumption in an
appropriate way, that can trigger a sustained change, and that is something
that is transferable. It is a good basis to start, to talk about levels of
alcohol consumption that are associated with harm," she says.

Facts and figures

– One in 25 adults is dependent on alcohol

– 1.7 million men and 0.6 million women drink at very risky levels – 50
units a week for men and 35 units a week for women

– Among 16- to 24-year-olds, 38 per cent of men and 21 per cent of women
regularly drink twice the recommended safe levels of alcohol

– 10,000 people a day are attending alcohol services for help with their
alcohol problem – of these 66 per cent are men, 36 per cent are unemployed and
18 per cent are either homeless or in temporary accommodation

– The majority (85 per cent) have problems solely associated with alcohol
and do not use any illegal drugs

– Workers who misuse alcohol are two to three times more likely to be
involved in industrial accidents

– 46 per cent of UK firms report problems of alcohol misuse among employees;

– Alcohol-related problems cost British industry an estimated £2bn a year
due to absenteeism and poor work performance.

Source: Nursing Council on Alcohol

Aims of the Nursing Council on Alcohol

– Arranging local, regional and national symposia, and education and
training programmes

– Establishing a network of knowledgeable individuals with an interest in
alcohol problems who can train, educate, support and advise nurses

– Providing information, advice and support in the form of direct contact,
newsletters and web site

– Providing guidance and support for nurses who have professional contact
with the client or patient who is experiencing alcohol-related problems.

Knowledge and understanding of alcohol use is constantly changing, says the
Nursing Council on Alcohol.
The challenge is to remain open to the information that will help the nurse

– Appropriate therapeutic intervention

– At the appropriate level

– At the appropriate cost

– With the appropriate level of understanding of the patient or client
presenting with the problem.


Alcohol Concern

Medical Council on Alcoholism

Alcoholics Anonymous

Institute of Alcohol Studies

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