Considering alcohol as a drug changes patient perceptions, study finds

Treating alcohol as a drug that interacts with medicines and conditions, rather than a lifestyle question on structured medicine reviews (SMRs) gives patients a new perception of their alcohol use, a small-scale study has found.

As part of wider research on whether alcohol should be included on medication reviews as a legitimate subject for discussion with pharmacists, researchers from the University of York and the London Metropolitan University aimed to understand barriers to and opportunities for discussing alcohol consumption within SMRs.

Previous studies have found that pharmacists are not confident with the subject of alcohol, do not feel it is their job to address alcohol issues beyond giving consumption advice, and are worried about how to deal with any difficulties that might arise if they open up discussion.

In this study, researchers trialled a Medicines and Alcohol (MAC) approach which linked alcohol consumption to medications and conditions.

Five clinical pharmacists working at different practices within a primary care network (PCN) in Northern England recruited 10 eligible patients who consumed alcohol at least twice a week.

The patients were then interviewed by lead researcher Mary Madden by telephone or video call around their alcohol and medication practices, experience of the SMR, and their views on discussing alcohol with health professionals and on the inclusion of alcohol framed as a drug.

They found that SMRs were often a ‘box-ticking’ exercise that ‘afforded little space for patients to raise concerns relating to drinking alcohol’.

‘Where alcohol was included at all, this was as a cursory check of units consumed, sometimes with minimal information given on recommended units, without consideration of the specific implications of taking this drug in combination with others,’ the study found.

Clinical pharmacists therefore missed important opportunities for intervention, such as discussing the ways that alcohol might interact with medicines for cardiovascular disease and diabetes, drugs which increased risk of stomach bleeding and antidepressants which impacted on the central nervous system, the researchers said.

The study found that in interviews, patients initially discussed alcohol separately to their health and illness, but when asked about the MAC approach, began to make their own connections between their drinking and health.

The researchers suggested that taking a MAC approach could challenge the assumption that alcohol was only a problem for ‘an extreme, stigmatized minority’.

Those interviewed by the researcher were interested in receiving information on how medications interacted with alcohol and how this might affect their health, as long as this was done sensitively.

And clinical pharmacists also said that they were interested in learning more about how to discuss alcohol as a pharmacologically active drug during SMRs.