Emergency departments are well placed to identify alcohol misuse problems

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7332.300c (Published 02 February 2002) Cite this as: BMJ 2002;324:300
  1. Robert Patton, research associate (r.patton{at}ic.ac.uk),
  2. Mike Crawford, senior lecturer,
  3. Robin Touquet, director of accident and emergency services
  1. Department of Public Mental Health, Faculty of Medicine, Imperial College of Science, Technology and Medicine, London W2 1PD
  2. St Mary's Hospital, London W2 1NY

    EDITOR—We agree with Foster that greater attention must be paid to alcohol use disorders if national and international targets for suicide reduction are to be met.1 Accident and emergency departments have a central part to play in tackling the link between alcohol misuse and suicidal behaviour as most patients with deliberate self harm present there.

    Research has indicated that over half of men who present to hospital after deliberate self harm have consumed alcohol in the few hours preceding the attempt, half regularly drink excessive amounts of alcohol, and 23% are alcohol dependent.2 Despite this strong association many patients who present to hospital after deliberate self harm do not have their alcohol use assessed.3

    At the accident and emergency department at St Mary's Hospital, in inner London, the proportion of patients whose alcohol consumption is assessed has been greatly increased by the introduction of the Paddington alcohol test.4 This test takes less than a minute to complete and provides a reliable indication of the presence of alcohol use disorders. Those with positive scores are offered brief intervention from staff working in the department, which may include literature about safer drinking or an appointment with an alcohol health worker.

    Providing assessment and treatment for people who attend accident and emergency departments after deliberate self harm is complicated because many people are reluctant to take up offers of help.5 A recent audit of the management of alcohol problems in St Mary's accident and emergency department showed that of 34 patients who presented after deliberate self harm and yielded positive scores on testing, 24 were prepared to take up an offer of further advice about their alcohol consumption. We are currently examining the effects that this advice has on the likelihood of further suicidal behaviour.

    This evidence suggests that people who present to accident and emergency departments after deliberate self harm and who drink excessively are willing to accept offers of help. It emphasises the importance of identifying alcohol misuse problems in patients in accident and emergency departments.


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