Over a million people are admitted to hospital each year due to alcohol abuse. Did the Department of Health's effort to tackle the problem work? Middlesex expertise found out
The story of alcohol abuse and the NHS doesn't begin and end in A&E departments on a Saturday night. Many of the 1.2m alcohol-related hospital admissions (ARHAs) each year are due to long-term conditions caused by drinking, and they have doubled over the past decade. In 2008, the NHS launched a three-year initiative in England called the Alcohol Improvement Programme (AIP). Its aim – an ambitious one, given the relatively short timescale - was to reduce the number of ARHAs.
In each English region, a regional alcohol manager was appointed to co-ordinate the effort. Support from a National Alcohol Support Team and additional financial support was provided for 25 primary care trusts, which were among those with the heaviest drinking problem; many of these were located in parts of the north-east and north-west. All the professionals involved shared learning and best practice on a website, the Alcohol Learning Centre.
Professor Betsy Thom led the team who evaluated whether the £22m programme had been a success. And by its own measure - the number of ARHAs - it was not: the number of admissions continued to rise across all regions. But, as she points out, that doesn't mean the programme should be written off. Far from it: Prof Thom's report identified several initiatives that she believes will pay off in the effort to drive down the burden alcohol misuse places on the NHS. Putting alcohol liaison nurses into A&E to liaise with primary care staff has been a success, and so was the advice delivered in pharmacies. The Alcohol Learning Centre - now part of Public Health England, under the current reorganisation of the NHS - continues to be a very useful resource for professionals, and the links established during the Programme have helped them work together more effectively.
"The majority of respondents were positive about the AIP," say Prof Thom and her team in their report. In fact, the target of reducing ARHAs may have been a victim of its own success by encouraging medical staff to identify alcohol misuse as a contributing cause to more diseases than they were doing before. Prof Thom's decades of expertise in alcohol-related harm enabled her to deliver a far more nuanced evaluation of the AIP than would have been possible if it had looked at ARHA rates alone. It takes more than three years to tackle the damage inflicted on patients by years of heavy drinking.
Prof Thom, who is head of the Drug and Alcohol Research Centre at Middlesex University, started her career in an academic unit specialising in medical sociology before moving to the Institute of Psychiatry to look at women's health. She still takes a special interest in women's drinking - "there's still much more stigma attached to women drinking to excess than men" - bingeing and illicit drug use, and how public policy can tackle them. Prof Thom is one of the sociologists taking part in the Addiction and Lifestyles in Contemporary Europe: Reframing Addictions Project (known as Alice Rap), a five-year project funded by the European Commission. She is also special issues editor of the Drugs: Education, Prevention and Policy journal, hosted by Middlesex.