Social drinking can very easily become heavier for some patients, increasing their risk of ill health. However, pharmacy teams are well-placed to help, writes Pharmacy Complete’s Michael Holden

Key learning points

• Problem drinking in England is at a high level

• Many patients are unaware of how little alcohol a unit contains

• January is often a good time to run alcohol awareness campaigns

Alcohol is widely used in numerous social situations and for many is part of enjoying life. However, there are currently more than 10 million people in England drinking at levels that increase their risk of harm.

Among those aged 15 to 49, alcohol is now the leading risk factor for ill health, early mortality and disability, and the fifth leading risk factor for ill-health across all age groups. There are now more than one million hospital admissions relating to excessive alcohol intake each year and more lives are lost in England as a result of alcohol
than from cancer.1

With an estimated 1.8 million customers a day, 1.2 million of them seeking healthcare advice, community pharmacies are well-placed to have a positive impact on the health and wellbeing of the communities and populations we serve through the delivery of accessible, high-quality services.

This includes increasing awareness of less risky alcohol consumption through health promotion campaigns and brief interventions with additional support or signposting to other support agencies as appropriate.


What is the problem?


The public health burden of alcohol is wide ranging, relating to health, social and economic harms. Harms can also be intangible, including poor quality of life or the emotional distress caused by living with a heavy drinker.

The consequences might be relatively mild, such as social disturbance from drinking in the streets, or they might be as severe as death or lifelong disability. Many of these harms affect other people, including families, friends, colleagues and the general public.

There are many health impacts including cancers, heart and liver disease, depression and an increased risk of sexual abuse and fall injuries.

In 2014, over 10 million adults were regularly drinking more than 14 units of alcohol each week. Of these, 1.9 million were drinking at high-risk levels, defined as more than 35 units per week for women and more than 50 units per week for men.


What is being done nationally?


There are three main influencers of alcohol consumption: price (affordability), ease of purchase (availability) and the social norms around its consumption (acceptability). There are a number of policies that have been developed with the aim of reducing the public health burden of alcohol, ranging from taxation and pricing, regulating availability, through to education and information.

Health interventions for drinkers who are already at risk are identification and brief advice, and specialist treatment for people with harmful drinking patterns and dependence.

These are effective approaches to reducing consumption and harm in these groups. However, their success depends on large-scale implementation and dedicated funding and resourcing, without which they are less effective.


What are the guidelines?


The chief medical officer’s (CMO) low-risk guidelines2 for both men and women
state that:

• To keep health risks from alcohol to a low level, it is safest not to drink more than 14 units a week on a regular basis.

• If you regularly drink as much as 14 units per week, it’s best to spread your drinking evenly over three or more days and have at least two alcohol-free days a week.

• If you have one or two heavy drinking episodes a week, you increase your risk of death from long-term illness and injuries.

• Alcohol should be totally avoided during pregnancy or while trying to conceive.


What is a unit of alcohol?


The answer is: not very much. Also, it depends on the strength of the drink. Most people are unaware of what a unit is so there is an opportunity for community pharmacy to increase awareness.


How can pharmacy help?


One of the requirements for Healthy Living Pharmacies (HLPs) is to run a minimum of six health promotion campaigns each year, one of which should involve taking the campaign out into the community. Alcohol awareness could be one of those and January is often a good time to do this after the festive period.

An effective campaign consists of more than putting up a poster and a few leaflets. It requires the whole team to understand why this is important, what the implications of higher-risk drinking are and proactively providing support and advice on less risky behaviours.

In some areas, local authorities have commissioned pharmacies to deliver an alcohol identification and brief advice (IBA) service and this has had positive benefits on alcohol-related health and social issues.


What training is available?


Health champions will have already gained an awareness of unhealthy lifestyles, including risks relating to alcohol consumption, as part of achieving their Royal Society of Public Health (RSPH) Level 2 award in understanding health improvement.

However, it is important that the whole team has a basic knowledge of risks and guidelines and knows how to proactively engage the public in healthy conversations. This can be achieved by referring to the health champion training or exploring information on websites including NHS Live Well3, One You4 and Drinkaware.5

Increasingly, we are seeing additional training on ‘making every contact count’ (MECC) given to pharmacists, health champions and pharmacy teams.

MECC is an approach that focuses on healthy conversations using ‘open discovery questions’ which begin with ‘what’ and ‘how’ to understand what people know, believe and want rather than telling them what to do.

Full MECC accreditation requires a combination of face-to-face and e-learning. However, an introduction to MECC is available on the e-learning for health portal.6 The portal also has specific training for community pharmacy on alcohol IBA.7

Pharmacy Complete also sells a pack of health knowledge and conversation cards8 covering major health issues including alcohol. These can be used to support the whole team.


What resources are there?


There are a number of places you can source health promotion posters and leaflets including Public Health England’s campaign resource centre9 and Drinkaware. There are also cards available that use a validated tool called Audit-C to assess drinking levels and risk, and leaflets to offer hints and tips to reduce risk.

Build an eye-catching display for the campaign to attract the attention of the public and help start a conversation. Consider using empty bottles and plastic glasses labelled with the number of units.


What practical advice can you give patients?


By asking open discovery questions, you can quickly understand an individual’s current behaviours, beliefs and motivations. People often have their own solutions, so you have the opportunity to tease these out and plant the seeds of a plan.

To help, you can also advise people to drink more slowly and with food, alternating with water or other non-alcoholic, low-sugar drinks. For those individuals requiring more help, you need to know where to signpost them to locally for more support.

While many of us enjoy an occasional drink, alcohol is undeniably a significant threat to the health and wellbeing of individuals and communities. Pharmacy teams can play a major role by increasing awareness and supporting people to help them reduce their own risk.

Promoting healthy lifestyles in and outside the pharmacy is also a great way of promoting your pharmacy and what you do beyond supplying or selling medicines. Many people are still unaware of the broader services we provide.

Michael Holden is a pharmacist and principle associate of Pharmacy Complete


1 The public health burden of alcohol and the effectiveness and cost-effectiveness of alcohol control policies.

2 How to keep health risks from drinking alcohol to a low level.

3 Alcohol support NHS Live Well.

4 One you, drink less.

5 Drinkaware.

6 E-learning for healthcare.

7 E-learning for healthcare, alcohol identification and advice.

8 Pharmacy Complete championing health cards complete pack.