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NETWORK A national newsletter on substance misuse management in primary care network NETWORK 32 MAY 2011

Alcohol: the real public health emergency

Whichever way you look at it, alcohol related problems dwarf those of drug dependency, resulting in 2.5 million deaths each year worldwide. No wonder the World Health Organization (WHO) has declared the harmful use of alcohol the world’s third largest risk factor (and second largest in Europe) for premature mortality, disability and loss of health1


And then there’s the social impact reaching deep into society, including violence, risk of traffic accidents, teenage pregnancy, child neglect and abuse, loss of work and negative effect on co- workers, relatives, friends and even strangers.

Never mind the White Paper2

Figure 1: common risk factors and how much illness they cause (WHO 2000) and who precisely will have responsibility

for alcohol in the brave new world, we all need to own this problem and address it. Health care professionals (and those working with people who use drugs in particular) have many opportunities to do this.

Whether you are seeing folk in general practice or a shared care substance misuse clinic or commissioning services, my message is quite simple: we need to wake up and address the whole spectrum of alcohol misuse in the people we see. I think there are four main barriers to doing so.

1 World Health Organization (2011) Global Status Report on Alcohol and Health 2011

2 Department of Health (2010) Health lives and healthy people: our strategy for public health in England

In this issue

Alistair Sinclair describes the origins and the underlying principles of the UK Recovery Foundation, an organisation that embraces recovery while recognising the importance that treatment services can play in this process. Page 4.

Fabrizio Schifano gives us insight into the fast growing and often confusing world of legal highs, and provides a few tips on how to identify and meet the needs of those who are using them. Page 5.

Paul Hayes takes us through the next steps of the Drug Strategy and argues that doctors will have a vital role to play in securing the future of effective drug and alcohol treatment locally. Page 6.

Though we have improved detection of hepatitis C in recent years, we could be doing much better

at getting people into treatment. Euan Lawson draws our attention to the issues on Page 8.

David Nutt outlines what is understood about the complex relationship between addiction and the brain. Page 9.

Tim Sampey describes how the London User Forum used its strengths when its funding was cut to produce an even stronger organisation. Page 10.

In the rush to meet targets and provide evidence based practice we can miss an essential element of care. Teresa Wirz discusses the importance of being kind when working with people. Page 11.

The prevalence of mental health problems is high amongst those in contact with addiction services but how good are we at assessing

for this? Scott Payne gives us some food for thought and a few ideas on how to improve our practice. Page 12.

Jack Leach provides advice about managing a patient who does not appear to be progressing in treatment. Page 13.

Chris Ford is Dr Fixit to a GP who is wondering whether or not to prescribe benzodiazepines to a patient. Page 15.

See all the latest courses and events. Page 16. We hope you enjoy this edition. Editor

@ 1. We underestimate the scale of the problem

The impact of alcohol misuse is widespread, encompassing alcohol related illness and injuries as well as significant social impacts. As alcohol has become increasingly affordable (65% more than in 19803

) consumption has increased: by 121% between 1950

and 2000. One in four adults now drinks above safe government recommended limits and there has been a corresponding rise in alcohol related disease and mortality; the cost to the NHS alone is an estimated £2.7 billion a year, and if social costs are included then it’s a whopping £25 billion4

. 3 Office for National Statistics (2007)

4 Department of Health (2008) Reducing Alcohol Harm: Health services in England for alcohol misuse

…continued overleaf

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