The following points were drawn up by the guideline development group to reflect the issues likely to be of most concern to patients and carers. These points are provided for use by health professionals when discussing alcohol problems with patients and in guiding the production of locally produced patient information materials.

7.1 Patient fears and perceptions when presenting with an alcohol problem

Research carried out by System Three Social Research,² and the SIGN patient involvement project, commissioned by the Scottish Executive, has identified recurrent themes of concern to patients presenting with an alcohol problem.

There is a widespread acceptance that the GP is the most appropriate first point of contact once a patient has decided to seek help. However, there are considerable fears or reservations associated with seeking such help even where a good relationship exists with the GP. Such fears include:

• the normal shyness or hesitancy associated with a condition perceived to be “shameful”
• being labelled an “alcoholic”
• jeopardising one’s work by admitting to having an alcohol problem
• being concerned that children may be taken into care
• not being treated seriously or being told to “pull yourself together”.

Other general points to emerge from the SIGN research and the literature:

• continuity of personnel providing support is essential as establishing trust is very important
• speed of referral is also very important as, once the difficult decision to seek help has been made, it needs to be followed up quickly or this positive attitude may evaporate
• there are wide differences in understanding of the terms ”alcohol misuse”, “alcohol problems”and “alcoholic”.

A common usage is for alcohol misuse to mean “beginning to impinge on normal life” and alcoholism to mean the above plus “a need or compulsion to drink” (see section 1.2 for medical definitions)

• there is confusion regarding what constitutes the standard unit of alcohol
• patients may have heard of Alcoholics Anonymous but will rarely have any knowledge of its methods or operations
• there is widespread belief that there are substantial facilities for sufferers from drug abuse but very little for those with alcohol problems.

7.2 Key messages for patients

Problems with alcohol are suffered by people in varying degrees, ranging from occasional excess consumption to an addiction or dependence, which may affect the person and their whole lifestyle. Patients often progress from mild misuse of alcohol to more extreme stages so it is important to try to address any problem at an early stage, seeking medical assistance where necessary.

7.2.1 EFFECTS ON THE PERSON

At a personal level alcohol misuse has many effects including:

• anxiety, which often leads to a compounding of the problem
• health problems caused by the alcohol consumption itself including liver and brain damage and other serious conditions such as epilepsy and heart disease
• consequential health problems caused by the effects of alcohol such as malnutrition, injuries and gaps in memory
• difficulties in sustaining employment.

7.2.2 EFFECTS ON THE FAMILY

Having a family member with an alcohol problem can seriously affect the family, where family members and friends can become anxious, depressed or alienated.

Financial problems caused by the purchase of alcohol, coupled with reduced earnings potential also impact on the family.

7.2.3 HELP AVAILABLE FROM THE PRIMARY CARE TEAM

The range of advice, treatment and referral available from the GP and the primary care team includes:

• initial discussion and support
• advice regarding non-hazardous drinking levels and ways to reduce drinking
• counselling and therapy for the individual
• counselling and therapy for the family
• treatment options including medication to relieve the physical effects of stopping drinking and to help to reduce the incidence of drinking in the longer term
• referral to a specialist nurse, often within the practice, for individual help
• referral to another agency for clinical care with information about treatment options available
• referral to a voluntary agency for lay counselling
• link with a mutual help association such as Alcoholics Anonymous
• longer term support and monitoring.

It should be stressed to patients that stopping or cutting down their drinking can only result from their own decision to do so. Any treatment, from whatever source, can only be an aid to taking this decision and following it through.

7.3 Organisations which provide useful information

AL-ANON
Mansfield Park, Unit 6, 22 Mansfield Street
Glasgow, G11 5QP
24h telephone service: 0141 339 8884
Website: www.al-anonuk.org.uk
Support for families and friends of alcoholics

Alcoholics Anonymous
National helpline: 0845 76 97 555
Website: www.alcoholics-anonymous.co.uk

Alcohol Concern
Waterbridge House. 32-36 Loman Street
London, SE1 0EE
Tel: 020 7922 8667 (Information Team)
Email: info@alcoholconcern.org.uk
Website: www.alcoholconcern.org.uk
Provides information on a wide range of alcohol related subjects. Alcohol Concern does not operate a helpline.

Alcohol Focus Scotland (formerly the Scottish Council on Alcohol)
2nd floor, 166 Buchanan Street
Glasgow, G1 2LW
Tel: 0141 572 6700, Fax: 0141 333 1606
Email: admin@sca-online.co.uk
Website: www.alcohol-focus-scotland.org.uk

Down Your Drink
Online program for reducing drinking
Website: www.downyourdrink.org.uk

National Alcohol Information Resource
Information and Statistics Division
Trinity Park House
Edinburgh, EH5 3SQ

NHS 24
Tel: 08454 24 24 24
Website: www.nhs24.com

NHS Health Scotland (formerly the Health Education Board for Scotland)
Woodburn House, Canaan Lane
Edinburgh, EH10 4SG
Tel: 0131 536 5500, Fax: 0131 536 5501
Website: www.hebs.org