The drink detectives

In the past few weeks UK medical schools have been allocated £650 000 (€0.82m; $1.27m) to teach medical students how to recognise alcohol misuse (http://news.bbc.co.uk, 14 Mar 2008 “Medics taught to spot drink abuse”). Dawn Primarolo, the public health minister, said at the BMA’s public health conference in March that the identification and treatment of alcohol misuse will become part of the compulsory curriculum of bachelor of medicine and surgery degrees, giving rise to 60 000 specifically trained clinicians in the next 10 years. “Doctors and nurses are our eyes and ears when it comes to identifying problem drinkers,” she said.

Government statistics show that alcohol misuse contributes to as many as 22 000 deaths a year in the United Kingdom. An estimated 530 people die in incidents related to drink-driving, and alcohol is involved in 19 000 sexual assaults. And 360 000 experience domestic violence driven by alcohol (www.number-10.gov.uk/files/pdf/SU%20interim_report2.pdf).

More than one in three men and one in five women exceed the government’s limits for sensible drinking. In any year about 5% of the population is dependent on alcohol, and many more people consistently drink beyond recommended limits. And each year alcohol costs the NHS as much as £1.7bn, the workplace £6.4bn, and public services and the criminal justice system £7.3bn.

This problem generally affects the entire Western world. A study in Germany in 2003 concluded that there is a comparable prevalence of bingeing in Germany, the UK, most other western European countries, and the United States (Addictive Behaviours 2006;32:505-15; doi: 10.1016/j.addbeh.2006.05.017).

The chronic misuse of alcohol can adversely affect a wide range of body systems, increasing the risk of gastrointestinal, cardiovascular, neuropsychiatric, malignant, and perinatal conditions. Hospitals have as many as 91 000 admissions a year that result from chronic alcohol abuse. Are the implicit long term health problems being forgotten or even ignored?

Training medical students

The first step in management is identification, which involves screening individuals for alcohol misuse. Anne Lingford-Hughes, reader in biological psychiatry and addiction at Bristol University, said, “Alcohol and addiction is relevant both to medical students and doctors as individuals, and to their patients. It does concern me that some medical students are not being sufficiently trained.”

Medical experts in alcohol misuse and addiction are pleased to hear about the investment, but have questions about where the money will go. Dr Lingford-Hughes said, “Although this money has been announced publicly, how it is being distributed has not been explained. It is not yet clear where exactly the funds will go or whether individual medical schools will have to apply for them.”

And how will such a multifactorial subject be integrated into the curriculum? “Addiction and alcohol misuse is relevant to many aspects of medicine, but currently often it is only taught in detail within psychiatry, and even here it probably does not get enough time. The subject generally needs a local champion within each university to see it is sufficiently covered,” she said.

Binge culture

The current binge drinking culture is prominent in media headlines and celebrity photographs. And well publicised statistics and scare stories don’t seem to be allaying people’s taste for a tipple too many—medical students included. Will training medical students as the eyes and ears of the drinking epidemic convince them to modify their own drinking?

The 16-24 year old range is statistically most severely affected by excessive drinking. For many students drinking is an integral aspect of university life, whether it’s related to sports, social life, or stress relief. One third year medical student admits, “We don’t think twice about drinking till we throw up, pass out, or someone takes us home.” Bingeing has become normal in student life—and in some circles expected.

Michelle Penn, vice president of the students’ union at St George’s Medical School in London, said, “For many alcohol is an important part of student life. Although medical students are educated about the risks of alcohol misuse, the binge drinking culture that is seen all over the UK is also prominent in medical schools. This, combined with the high pressured lifestyle that doctors face, raises serious concerns about the wellbeing of our students and the potential for alcohol misuse in the future.”

Physician, treat thyself?

Medical students face the risks of short term excess, but they are not immune from the dangers of longer term dependence either. They will be immersed in a demanding and stressful profession. It has been shown that medical students’ alcohol use rises considerably in the course of their studies, and that the use of alcohol as a stress reliever starts at university (Suom Laakaril 1995;50:2459).

In addition medical students are slower than most to seek necessary care for depression, anxiety, and stress. A BMA working group suggested in 1998 that one in 15 doctors in the UK may have some form of dependence on alcohol or other drugs (www.sick-doctors-trust.co.uk/problem.html).

Competing interests: None declared.

Provenance and peer review: Commissioned; not externally peer reviewed.

       

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