COMMENT

A
lcohol consumption is a considerable public
health burden in the UK. According to the
Department of Health (DH) (2008), the
consequences of alcohol misuse cost the country
2.7 billion pounds each year, with the annual cost
to healthcare of alcohol abuse calculated as 1.6
billion pounds (DH, 2005; 2008, 2011). The increased
number of patients being admitted with alcohol-
related complications is costing the NHS 3% of its
budget each year.
For a significant and growing number of people in
the UK, alcohol consumption is a major cause of ill
health, with more than 10 million people in England
(31% of men and 20% of women) regularly drinking
above the recommended alcohol limits (National
Audit Office (NAO), 2008). The incidence of
alcohol-related illness has risen over the past 20 years,
with the National Institute for Health and Clinical
Excellence (NICE) (2010) suggesting that 26% of
adults not only drink above the recommended limits,
but also drink in a manner that is actively harmful
(impacts adversely on human physiology and health).
The Office for National Statistics (ONS) states that
the number of alcohol-related deaths in the UK has
risen since the early 1990s, from the lowest figure of
4023 (6.7 per 100 000 population) in 1992 to the
highest of 9031 (13.6 per 100 000) in 2008 (ONS,
2011). These figures demonstrate the growing burden
posed by alcohol abuse on NHS staff and resources.
Current Government recommendations state that
men should drink no more than three to four units
of alcohol a day, and that women should drink no
more than two to three units a day. However, research
suggests that many men and women exceed these
recommended limits (DH, 2011). According to the
DH (2011), regularly drinking above recommended
daily limits significantly increases the risk of ill health
and alcohol-related health problems.
Consequences of alcohol misuse
The health and social consequences associated with
alcohol misuse are immense. Indeed, the British
Medical Association (BMA) has described an
epidemic of alcohol misuse in the UK (BMA,
2008). NICE (2010) defined harmful drinking as a
pattern of alcohol consumption which is over the
recommended weekly amount that causes mental
or physical damage. Excessive alcohol intake is
associated with liver disease and liver cirrhosis.
Although alcoholic liver disease can be slow and
progressive, taking up to a decade to present itself with
life-threatening symptoms, if the liver is subjected to
excessive intake of alcohol over a long period of
time, its ability to function normally is compromised.
Other causes of death associated with alcohol abuse
include stroke, cancer, cardiovascular disease and
accidental injury.
Alcohol and mental health
Although the effects of alcohol on the body can
be serious and detrimental, the burden of excessive
alcohol consumption doesnt just affect physical
health; the psychosocial impact of alcohol abuse has
also emerged as a concern for health professionals. It
has been reported that people who consume high
amounts of alcohol are vulnerable to higher levels of
mental health problems, and that excessive alcohol
intake is a contributory factor in mental illnesses such
as depression (Miller et al, 2011). Excessive alcohol
consumption has also been linked to road traffic
accidents, family breakdown, work, financial and legal
problems, and domestic violence. Indeed, almost half
of all victims of violence report that perpetrators
were under the influence of alcohol (Motluk, 2004;
Livingston, 2011). The health, economic and social
burden of alcohol abuse is of significant concern.
What is being done?
In 2010, the Government launched The Coalition:
Our Programme for Government, containing several
commitments to tackle the harmful use of alcohol.
These include: banning the sale of alcohol below
cost price, reviewing alcohol taxation and pricing to
tackle binge drinking, doubling the maximum fine for
under-age alcohol sales to 20 000, and overhauling
the Licensing Act to give local authorities and the
police much stronger powers to remove licences from
premises that are causing problems.
Nurses role
While these measures may help address some of the
problems associated with alcohol misuse, it is nurses
who are best placed to tackle excessive alcohol intake
and its associated problems (Ryder et al, 2010).
Nurses have a key role to play in promoting
health and influencing the health of individuals and
communities. According to the NAO (2008), early
alcohol-associated interventions such as identification
and advice can bring substantial health benefits and
savings, and it has been shown that early intervention
by specially trained nurses can reduce alcohol intake
and positively assist people with alcohol-related
problems (Ryder et al, 2010).
Where can we go from here?
What is needed now is a strategy for dealing with
excessive alcohol consumption in the UK, and the
implementation of interventions to reduce the high
The health and psychosocial
burden of alcohol abuse
212 British Journal of Nursing, 2012, Vol 21, No 4
Editorial Board
Russell Ashmore, Senior Lecturer in
Mental Health Nursing, Sheffeld Hallam
University
Steve Ashurst, Critical Care Nurse
Lecturer, Maelor Hospital, Wrexham
Christopher Barber, Residential Nurse
Dimitri Beeckman, Lecturer and
Researcher, Florence Nightingale School
of Nursing & Midwifery, Kings College
London
Ruhi Behi, Head of School, School of
Healthcare Sciences, University of Wales,
Bangor
Martyn Bradbury, Clinical Skills Network
Lead, University of Plymouth
Alison Coull, Lecturer, Department of
Nursing and Midwifery, University of
Stirling, Scotland
Willie Doherty, CNS Continence Care,
Park Drive Health Centre, Baldock,
Hertfordshire
Jane Fox, Independent Consultant,
Derbyshire
Alan Glasper, Professor of Child Health
Nursing, University of Southampton
Angela Grainger, Assistant Director of
Nursing, Kings College Hospital NHS
Trust, London
Michelle Grainger, Ward Manager,
Moseley Hall Hospital, Birmingham
Helen Holder, Senior Lecturer, Nursing
Studies, Birmingham City University
Mina Karamshi, Specialist Sister in
Radiology, Royal Free Hospital, Hampstead
John Keady, Professor of Admiral
Nursing, Northumbria University,
Newcastle-upon-Tyne
Andrew McVicar, Reader, Dept of Mental
Health & Learning Disabilities, Anglia
Ruskin University
Danny Meetoo, Lecturer in Adult Nursing,
University of Salford
Mervyn Morris, Director, Centre for Mental
Health Policy, Birmingham City University
Cyril Murray, Senior Lecturer, University
of Salford
Aru Narayanasamy, Associate Professor,
University of Nottingham
Mike Nolan, Professor of Gerontological
Nursing, University of Sheffeld
Ann Norman, RCN Criminal Justice
Services Nursing Adviser and Learning
Disability Nursing Adviser (U.K)
joy Notter, Professor, Birmingham City
University, UK & Saxion University of
Applied Science, NL
Lynn Parker, Independent Educational
Adviser, Infection Control, Sheffeld
Hilary Paniagua, Senior Lecturer, School
of Nursing & Midwifery, University of
Wolverhampton
Ian Peate, Head of School, Nursing,
Midwifery and Healthcare, Thames Valley
University
Bernadette Porter, Nurse Consultant,
Multiple Sclerosis, National Hospital
for Neurology and Neurosurgery, UCLH
NHS Trust
Jo Sharman, Operational Commissioning
Manager, University Hospitals Birmingham
NHS Foundation Trust
John Tingle, HRS Reader in Health Law,
Nottingham Law School, Nottingham Trent
University
Bernice West, Academic Director, School
of Nursing and Midwifery, Robert Gordon
University, Aberdeen
Catherine Whitmore, Research Nurse,
Diabetes and Endocrinology, University
of Liverpool
John Wilkinson, RCN Offcer, Royal College
of Nursing, Eastern Region
Jo Wilson, Director, Wilson Healthcare
Services, Newcastle
Cate Wood, Lecturer, Bournemouth
University, PhD student at London School
of Hygiene and Tropical Medicine
Sue Woodward, Lecturer, Specialist and
Palliative Care, Florence Nightingale
School of Nursing and Midwifery, Kings
College London
British Journal of Nursing, 2012, Vol 21, No 4 213
Sarah Welton
3rd year Nursing Student, University of Glamorgan, Wales
Ray Higginson
Chartered Biologist and Senior Lecturer
University of Glamorgan, Wales
burden of alcohol-attributable disease. Primary care trusts must have
established drug and alcohol services, with nurses playing a key role in
their delivery.
Although providing nursing care to patients who abuse alcohol
is a complex and demanding task, nurses who possess the necessary
knowledge and skills to undertake patient assessment and appropriate
behavioural management techniques can have a positive impact
on all those patients affected by alcohol. As a profession, nursing
needs to continue to raise concerns about the serious health and
psychosocial problems associated with alcohol abuse, and work with
other professionals to improve alcohol intervention strategies.
Ceccanti et al (2002) have shown that nurses working in accident and
emergency departments are best placed to recognize and treat patients
affected by alcohol-related problems, such as acute alcohol intoxication
(AAI), alcohol withdrawal (AW), and traumatic or spontaneous illness
owing to acute or chronic effects of alcohol abuse. This highlights the
central role that nurses can play in alcohol abuse treatment. Recently,
the chief medical officer for Wales has identified tackling alcohol
misuse as a major health priority. In a recent pilot study conducted in
partnership between Cardiff University and the Welsh Government,
hospital patients with a drink problem are to be identified and offered
help by specially trained nurses. Working in trauma units, these specialist
nurses will talk to all patients with an injury to identify alcohol misuse.
The fast alcohol screening test (FAST) flags up drink-related problems,
allowing the nurses to talk to patients about any drinking issues.
Professor Jonathan Shepherd, director of the Violence and Society
Research Group at Cardiff University, has recently stated that: Alcohol
misuse is a major problem in Wales. The death rate is alarming and far
too high. We know from our own research that most people injured
while intoxicated are young. Intervening early in a problem drinkers
life can make a real difference. Nurses working in injury clinics can
be hugely effective in helping patients tackle alcohol misuse (Cardiff
University, 2012).
It has been suggested that in order to meet the needs of patients
who abuse alcohol, information on the dangers of excess alcohol
intake should be incorporated into preregistration nurse education and
training (Hussein-Rassool and Rawaf, 2008).
Training on alcohol abuse screening, detection of alcohol problems
and highlighting obstacles in the identification of alcohol abuse, as
well as skills designed to assist in intervention should form part of
preregistration nurse education.

BJN
BMA Board of Science (2008) Alcohol misuse: tackling the UK epidemic. http://tinyurl.
com/74g8d39 (Accessed 13 February 2012)
Cardiff University (2012) Tackling alcohol abuse. http://tinyurl.com/7yjf576 (accessed 15
February 2012)
Ceccanti M, Nocente R, Diurni V, Pulimeno A, Torre R, Bertazzoni G (2002) The
nurses role in the identification and management of alcohol abuser in the Emergency
Department. Clin Ter 153(6): 389-96
Department of Health (2005) Alcohol Misuse Interventions: Guidance on developing a local
programme of improvement. Crown Publishers, London. http://tinyurl.com/yvfhaa (accessed
13 February 2012)
Department of Health (2008) The cost of alcohol harm to the NHS in England: An update to the
Cabinet Office (2003) study. Crown Publishers, London. http://tinyurl.com/5jjjtb (accessed
13 February 2012)
Department of Health (2011) Alcohol Statistics. http://tinyurl.com/73qru3s (Accessed 13
February 2012)
Hussein Rassool G, Rawaf S (2008) Educational intervention of undergraduate nursing
students confidence skills with alcohol and drug misusers. Nurse Educ Today. 28(3): 284-92
Livingston M (2011) A longitudinal analysis of alcohol outlet density and domestic violence.
Addiction 106(5): 91925. EPub.
Miller M, Borges G, Orozco R et al(2011) Exposure to alcohol, drugs and tobacco and
the risk of subsequent suicidality: findings from the Mexican Adolescent Mental Health
Survey. Drug Alcohol Depend 113(2-3): 1107
Motluk A (2004) Binge drinking among US adults. New Sci 183(2461): 28-33
National Audit Office (2008) Reducing Alcohol Harm: Health services in England for alcohol misuse.
http://tinyurl.com/7bwesez (Accessed 13 February 2012)
National Institute for Health and Clinical Excellence (2010) Alcohol-use disorders Diagnosis
and clinical management of alcohol-related physical complications. http://tinyurl.com/7zct3ym
(Accessed 13 February 2012)
Ryder SD, Aithal GP, Holmes M, Burrows M, Wright NR (2010) Effectiveness of a nurse-led
alcohol liaison service in a secondary care medical unit. Clin Med 10(5): 435-440
The Office for National Statistics (2011) Alcohol-related deaths in the United Kingdom, 2009.
http://tinyurl.com/6nj6q93 (Accessed 13 February 2012)
More than 10 million people in England regularly drink above the recommended alcohol limits
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Copyright of British Journal of Nursing (BJN) is the property of Mark Allen Publishing Ltd and its content may
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Copyright of British Journal of Nursing (BJN) is the property of Mark Allen Publishing Ltd and its content may
not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written
permission. However, users may print, download, or email articles for individual use.