NHS to set up new alcohol and tobacco services for patients admitted to hospitalBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l78 (Published 07 January 2019) Cite this as: BMJ 2019;364:l78
All rapid responses
Thirty years ago, a professor of psychiatry, Hamid Ghodse, set up the first Drug and Alcohol Liaison Team for St. George’s Hospital in Tooting. I was his lecturer for research & evaluation. Our initial priorities were the Maternity and Emergency departments, but over time patients were supported across the hospital: most referrals were alcohol-related (74%) 1. One young psychiatrist, Mervyn London, went from Tooting to Cambridge. There he inspired a proactive initiative to engage inpatients across Addenbrooke’s Hospital.2 Education of ward nurses and junior doctors, and subsequent audits, underpinned this engagement. London also led the community-based alcohol service, which developed imaginative ways 3 to treat individuals with long, unhappy alcohol histories, who had despaired of other services.
Sadly, very few of the addiction specialists I knew in the 1980s are still in practice, and repeated health reforms, implemented by commissioners with limited experience, meant that past hard-won knowledge has been lost today.
I am grateful to the Faculty of Public Health for connecting me to professor Eileen Kaner. She brought public heath understanding about Health Systems to analyse why most healthcare initiatives to improve alcohol screening had disappointing results.4 As well as professionals’ sense of poor ‘self-efficacy’ around alcohol disorders there was: a lack of Organisational support where addressing alcohol use was seen ‘as an additional burden on an already overloaded workforce’ and Training was either lacking or ‘did little to change practice’.
If 50 new alcohol care teams are created, we owe it to their staff (and patients) to create better Organisational support and Training that can transform the care delivered.
1] Williams H, Vince J, Salter M. Training experience in drug and alcohol liaison work. Psychiatric Bulletin 1995; 19: 758-760.
2] Dent THS, Shepherd RM, Alexander GJM, London M. Do CAGE scores predict readiness to reduce alcohol consumption in medical in-patients? Alcohol & Alcoholism 1995; 30: 577-580.
3] Buijsse N, Caan W, Fowler Davies S. Occupational therapy in the treatment of addictive behaviours. British Journal of Therapy & Rehabilitation 1999; 6: 300-307.
4] Derges J, Kidger J, Fox F, Campbell R, Kaner E, Hickman M. Alcohol screening and brief interventions for adults and young people in health and community-based settings: a qualitative systematic literature review. BMC Public Health 2017; 17:562 (doi 10.1186/s12889-017-4476-4
Competing interests: Member of the FPH special interest group for Alcohol, and public health advisor to the All Party Parliamentary Group on alcohol