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The Bulletin of the Medical Council on Alcohol Alcoholis The bulletin of the Medical Council on Alcohol April 2014 Vol 35; No. 2 ISSN 1351-054 for alcohol, the authors examine how the From the editor definition of brief interventions has changed In this issue over time, influenced by a number of factors, not least developments in thinking about the 1 Editorial nature of alcohol problems. 2 Alcohol at the The 2014 March/April issue of Alcohol and Roadside, the Alcoholism is devoted entirely to the topic of Emergency alcohol-related brain damage in adolescence Department [2]. This special edition covers this crucial & the Trauma topic from every angle, including policy, Centre epidemiology, marketing, genetics, brain functioning and imaging and interventions. 4 2014 Symposium Dr Dominique Florin The common point of all the articles is Programme: authorship of the highest calibre. ‘Alcohol & Older In this issue The recent decision by the Westminster People’ Last November, Professor Robin Touquet, government to shelve the proposal for 6 Book Review on our 2013 Max Glatt lecturer, gave a Minimum Unit Pricing was a disappointment Demons - our sparkling talk which captured his decades to many in the health field. Earlier this changing attitude as an emergency room physician. His year, the British Medical Journal published to alcohol, exposure to the harm caused by alcohol in a hard-hitting article detailing the political tobacco and this setting led him to his pioneering work events behind this decision. Most striking drugs reducing alcohol related harm through the was the extensive access given to the development of alcohol health workers and alcohol industry to reach politicians and Antidepressant the use of screening and brief intervention other policy makers, whilst health voices use, following in the emergency room. This is recounted in were consistently excluded. This resulted in 3 months in his article in this issue of Alcoholis. You may a policy where science came a far second recovery from also look at the MCA website where a video to industry interests. Both the original substance of Professor Touquet giving his Max Glatt article and the resulting commentary and misuse lecture is available. discussions are well worth reading [3]. 8 2014 Student We also have a piece whose lead author, 1 McCambridge J and Cunningham JA. The early Ewen McCance, is still a medical student. In history of ideas on brief interventions for alcohol. Competition Addiction 2014; 109(4):538-547. Update a small study of patients passing through a quasi-residential rehabilitation programme, 2 Alcohol and Alcoholism 2014; 49(2). Latest ‘Alcohol & notes were examined to explore the topical 3 http://www.bmj.com/about-bmj/article-clusters/ Alcoholism’ news issue of dual diagnosis. The authors remark alcohol that conclusion of treatment for a substance Winner of the MCA 2014 Max Glatt Lecture and use disorder may be associated with a New year Quiz Symposium on Alcohol and older people: decrease in use of anti-depressants. This We are delighted that our 2014 Max Glatt is of course a small observational study but lecturer will be Dr Allan Thomson. Dr suggests a need for further research in this Thomson, a long standing member of the area. MCA and founding editor of Alcohol and Professor Virigina Berridge is a historian Alcoholism, has had a most distinguished whose career has focussed on the history of career and has really been a pioneer on The Medical Council drugs and alcohol. For those of us working the topic of Wernicke-Korsakoff Syndrome, on Alcohol in this field in the ‘here and now’, her his chosen topic for the lecture. The Max 5 St Andrews Place work provides thought -provoking insight. London, NW1 4LB Glatt lecture will be followed by the annual In a review of her latest book, ‘Demons’, MCA symposium, this year on ‘Alcohol Tel: 020 7487 4445 Iain Smith reminds us how scientific and older people’. The symposium will be Fax: 020 7935 4479 understandings of drugs and addiction are of interest to health professionals across culturally and politically mediated. the range of specialties and disciplines for [email protected] In the medical press Another historical whom improving health care for older people overview is provided in Addiction [1]. In this and reducing alcohol-related harm are www.m-c-a.org.co.uk fascinating history of brief interventions imperatives. Registered Charity Alcoholis, the quarterley bulletin for health care professionals, is published by the Medical Council on Alcohol. Views expressed by Number 265242 contributors are not necessarily those of the MCA. We welcome any articles or comments from other parties which may be published. Alcohol at the Roadside, the Emergency Department Professor Robin Touquet and the Trauma Centre On the 14th November 2013, Professor Robin Touqet was the recipient of the MCA’s Max Glatt memorial medal: foster this delusion. Binge drinking, Max Glatt (1912-2002; founding with resulting memory loss, is an Trustee of the MCA 1967) brought increasingly common problem.8,9 It the treatment of drinking problems lays the foundations for adult alcohol- ‘in from the cold’. He unfolded the related disease.10 positive qualities of the rejected dependent drinker, always Patients must never forget that they supporting the underdog. He are responsible for their own health: gave the dependent drinker back ‘Robin Touquet’s Health Vowels’: their dignity and self-respect. (Dr ‘A’ is for Alcohol, not in excess, Spencer Madden, 1st Max Glatt Professor Touquet receiving his medal from ‘E’ is for Exercise, a must for all, Professor Drummond (MCA chairman) Lecture 2006). I thank the multi- disciplinary MCA for 21 years of ‘I’ is for Intake, for appropriate Brief Intervention (BI), 20-30 minutes alcohol education. This education diet and to avoid recreational by an AHW, remembering that BI was implemented at St Mary’s, Inhalation (and drugs), saves lives.14 Certainly AHWs being Paddington, to improve standards of ‘O’ is for Obesity, you must embedded within the ED and giving care1, 2 prevent, educative clinical support in real time to reduce junior doctor stress I focus on the hazardous drinker, ‘U’ is for Understanding that you, - e.g. to avoid the complications of highlighting ‘Functional Forgetting’ the patient, are responsible for alcohol withdrawal15,16 - generates (a very descriptive term coined by your own health. empathy and thus further referrals, Eileen Kaner, Professor of Public So for 2014, what is new for ED staff, with resulting reduced patient re- Health, Newcastle-upon-Tyne, UK) Trauma Surgeons, Alcohol Health attendance.17 and the ‘Alcostick’ (finger-prick test Workers (AHWs) and Paramedics? for alcohol, Surescreen Diagnostics, 4. ‘Why make myself so vulnerable?’ 2014). We know alcohol misuse 1. ‘Functional Forgetting’ neatly is what the young should feel after is a very common Emergency describes the variable lapses an alcohol related incident. The Department (ED) problem,3 and of recall (amnesia) in younger ‘Teachable Moment’ of opportunistic that alcohol is the most harmful hazardous drinkers (16 to 25), BA is the penny dropping that without commonly used drug.4 The potential associated with rapid acute alcohol they would not be in the ED long-term consequences for patients intoxication. Recall for what as a consequence of fall, collapse, have been clearly delineated.5 happened the night before is hazy. head injury, assault, accident or even 8,9 Families reject in life, but litigate in It is not a dense amnesia, more worse.18 Doctors’ attitudes are key, death.6 Hence the vital importance of a hazy, fragmentary forgetfulness. 19 medical students have certain early detection for young hazardous What is very sinister are the responsibilities different from those of drinkers – say 16-25 years of age increasing number of Functional MRI other students, with higher standards - before dependency sets in when Scanning studies that suggest heavy of behaviour being expected of brain chemistry is adversely, and episodic drinking in adolescence them.20 irrevocably, altered for life. This may be followed by subtle alterations 11,12 5. The ‘Screening & Intervention importance of early detection now in brain function. At present it Program for Sensible Drinking’ needs to be reflected in coding (ICD- cannot be answered how permanent, study, acronym SIPS, www.sips. 11, WHO, in preparation), so that or not, are such changes, and what iop.kcl.ac.uk/ demonstrates that hazardous drinking may be targeted their long-term implications are. effective leadership, together with for treatment.7 It must never be 2. The good news for raising AHW support, is necessary for forgotten that, ‘Every dependent standards of care is that in England implementation of an alcohol- drinker once started out as a there has been a 55% increase in misuse patient support policy. For . hazardous drinker’ the number of EDs that have direct sustainable implementation there Many young do not understand that access to Alcohol Health Workers must be a symbiosis between a 13 alcohol is a drug, rather they view (AHWs) between 2006 and 2011. senior ED clinical lead (Consultant alcohol as a ‘rite of passage’. So 3. AHWs educate ever-changing or Nursing Sister) and the AHW(s). called ‘urban regeneration’ with groups of ED doctors (as often One cannot be effective without the its greatly increased access to as every four months) and nurses other. In the USA, level I Trauma alcohol (even seducing the young about the real worth of giving Brief Centres must now screen for with ‘alcopops’), together with Advice (BA) - only 1-2 minutes of alcohol misuse, and provide BA/BI, society’s more relaxed view of feed-back - with the offer of further for certification and consequential drunkenness, have served only to funding.21 EDs may need such Alcoholis April 2013 2 Alcohol at the Roadside, the Emergency Department and the Trauma Centre Continued..
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