OPINION: Yes, tackle our national drugs death tragedy but don’t forget the harm caused by alcohol

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https://www.thecourier.co.uk/fp/opinion/3082784/opinion-alcohol-harms-scotland/

Alcohol continues to cause serious harm in Scotland, with 1190 people dying directly because of alcohol in 2020. Sadly, this figure is an increase of 170 from the previous year and the number of deaths was 4.3 times higher in the most disadvantaged areas compared to the least. Action is urgently required to address the deep-seated issues driving this patently unfair situation. Along with colleagues, I have explored how a specialist alcohol service that works closely with general practices can support people who have alcohol problems and who had problems engaging with alcohol services in the past.

People from disadvantaged areas often face several challenges when seeking help for alcohol problems. Many of these people feel ashamed and can find it difficult to reveal that they have an alcohol problem. Many also feel stigmatised by society and this may prevent them from seeking help in the first place. Additionally, for many of these people, their alcohol problems stem from mental or physical health issues, or social issues such as unemployment or unstable housing. Therefore, they need specialised support, not only for their alcohol problems, but for these other issues as well. Unfortunately, many of the current alcohol services in Scotland do not offer the special support this population group requires.

Our new study focused on a unique and specialised alcohol service, the ‘Primary Care Alcohol Nurse Outreach Service’ or PCANOS, that supports people with alcohol problems from the most deprived areas in Glasgow. The specially trained addiction nurses support people whose alcohol problem has seriously impacted their health, and who had problems engaging with other alcohol services in the past. Unlike other services, the addiction nurses work closely with GP practices, meaning that they are able to communicate effectively with GPs and other practice staff to provide the appropriate care to patients referred to PCANOS.

The GP practices refer patients with alcohol problems to PCANOS. The addiction nurses then visit the patients in their homes, and our study found that this helped to reducing feelings of stigmatisation among patients. It also helped the nurses to build trust with the patients, so that the patients feel safe to talk about their alcohol problems and the nurses can identify all the issues the patients need support with. Over 12 weeks, the nurses help the patients to reduce their alcohol intake and support them to gain better control of their drinking habits. The nurses also directly link the patients to social or mental health services if needed. Finally, the nurses put patients in direct contact with other alcohol services in the community for continued support before discharging them from PCANOS.

Our study found that the service was viewed positively by both practice staff and patients due to its person-centred approach, flexible nature, and ability to be tailored to support specific individuals. The model also enabled collaborative working between practice staff, leading to faster referrals and coordinated care between services and with wider community services after discharge.

Overall, PCANOS was shown to be important as it provided the appropriate support to a population group who are not supported by other alcohol services. If left unsupported, this group will continue to experience serious harms to their health and may eventually die of alcohol-related causes.

Our research was carried out in Glasgow, but are relevant to disadvantaged populations in Tayside, Fife and elsewhere in Scotland. The study showed that PCANOS is filling an important gap in alcohol service provision. Therefore, it is important that services such as this continue to be supported. Aside from cutting the human costs arising from alcohol problems, I would suggest that the Scottish Government considers rolling out PCANOS in areas of high deprivation where such as service does not exist, as this is an essential investment that will pay dividends in the long run.

In 2020/21, there were 35,124 alcohol-related hospital stays in Scotland (at a rate of 641 per 100,000 in the population).  Alcohol consumption is a causal factor for more than 200 disease and injury conditions. Additionally, alcohol harm costs the Scottish Government £3.6 billion per year (equivalent to £900 per person), including £405 million in NHS services.

Additional funding for Alcohol & Drug partnerships was recently announced by the Scottish Government, but this is centred more on illicit drugs rather than legal ones. This is perhaps understandable given the shamefully high rates of drug-related deaths in Scotland, but in the race to address one human tragedy we should not neglect another. PCANOS is not a silver bullet to solve all of Scotland’s alcohol-related harms, but it is filling an important service gap by supporting those struggling with an alcohol problem that is already negatively impacting their health.