In Scotland, alcohol-related deaths are more than four times higher in the most disadvantaged areas compared to the least disadvantaged areas. A recent study from the University of Dundee and University of Stirling found that embedding specialist Addiction Nurses within GP teams can help address alcohol problems in deprived areas.
In this blog, lead author Dr Andrea Mohan, examines why the role of the Addiction Nurse is so important.
Alcohol and health
Fact: Alcohol is harming the health of thousands of people in the United Kingdom.
Drinking any amount of alcohol can increase the risk of ill health; this risk significantly higher for higher risk drinkers – those who regularly drink more than 35 units (women) or 50 units (men) of alcohol per week. Higher risk drinkers are likely to experience adverse, long-term health conditions including various cancers, liver disease and heart disease, and are more likely to be hospitalised for an alcohol-related condition compared to lower risk drinkers. In Scotland, though there has been a decline in alcohol-related hospital admissions since 2007, there was a 17% increase in deaths directly caused by alcohol in 2020 compared to 2019. It is also estimated that alcohol misuse costs the Scottish economy £3.56 billion. These figures show that more needs to be done to reduce the harms caused by alcohol in Scotland.
Managing alcohol problems in primary care
General Practitioners (GPs) provide primary care to a large proportion of the population; this makes them well-placed to assess patients’ alcohol use, provide advice or brief interventions. However, brief interventions are not suitable for everyone. Individuals whose drinking is already seriously harming their health and those who have complex, underlying issues alongside their alcohol problem are examples of two patient groups that need more specialist intervention which most GPs cannot deliver. Enter the specialist Addiction Nurse.
The role of specialist Addiction Nurses
The role of specialist Addiction Nurses (ANs) in alcohol and drug treatment services is well-documented. In relation to alcohol, ANs use specialist skills and knowledge to deliver a wide range of interventions to diagnose, treat and support patients with alcohol problems. For example, they can accurately assess a patient’s physical and mental health, create a tailored care plan for the patient, provide behavioural counselling and educate the patient. ANs can also prescribe medicines, supervise the patient’s compliance to medication, help manage any side effects from medication and refer patients to other services for appropriate treatment.
Our recent study focused on a specialist alcohol service in Glasgow, the Primary Care Alcohol Nurse Outreach Service (PCANOS), that employs ANs who work closely with Deep End GP practices (practices that serve the most 100 deprived populations in Scotland). Patients whose drinking is adversely impacting their health, and who had low engagement with other alcohol services in the past, are referred by their GPs to PCANOS. The ANs visit patients in their homes and deliver specialist care over a 12-week period, with the aim of getting patients to reduce their drinking levels and link them to other alcohol services in the community for long-term support.
How do patients respond to Addiction Nurses?
We interviewed seven patients who used PCANOS. Interestingly, all reported that by engaging with PCANOS, they were able to reduce their drinking and felt that their health and wellbeing had improved. We found that the role of the ANs was crucial to this and want to highlight two important aspects of this role, based on our findings.
- The ANs built up a rapport with patients by being friendly, non-judgemental and honest, which in turn made patients learn to trust the ANs (two patients said they viewed their ANs as friends), and speak truthfully about how much alcohol they drank and why. Where possible, the ANs also tried to encourage family members to become involved in conversations and in the patient’s care, which led to improved family relationships.
One patient told us:
“…I would encourage family members to be there … the sneakiness, the lies, pulling money together from going to work, no eating from one day to the next and saving up a pound here and picking up a pound there and saving fifty pence here … it opened my mother’s eyes as well because it’s educated her … talking about alcohol with my mum was non-existent, my talking about alcohol with anybody was non-existent [before engaging with PCANOS] … now I sit and watch all the crap TV with her, and actually have a conversation you know.”
- The ANs focused on what the patients wanted, not what the nurses thought they needed, in relation to their drinking. In all cases it was to reduce drinking, not to completely stop. The ANs provided patients with coping strategies to manage triggers and to help them improve their eating or sleeping habits. The patients said this made them feel valued, more in control of their lives and motivated to reduce their drinking.
One patient said:
“They [another alcohol service] had the attitude that if you don’t stop drinking within two weeks, you won’t be able to for the rest of your life, you’re an absolute piece of sh*t … You were just a number [in the other alcohol service], I think. (The AN) made you feel that you weren’t just a number.”
Our study shows the benefits of ANs in engaging with an overlooked population group in relation to alcohol treatment – individuals with serious alcohol problems who have problems engaging with other alcohol services. As alcohol continues to cause significant harm to so many people, it is important that more ANs are employed in a variety of settings to target and support those in need of specialist alcohol care.
Written by Dr Andrea Mohan
This blog was published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Alcohol Health Alliance or its members.