The Government may have to make decisions, in the fight against alcohol abuse, which will result in a loss of money for the exchequer, a prominent consultant psychiatrist has warned.
Dr Siobhán Barry, who appeared last week before the Oireachtas Joint Committee on Arts, Sport, Tourism, Community, Rural and Gaeltacht Affairs, spoke to Irish Medical Times before she gave the presentation entitled Alcohol Abuse in the context of the National Drug Strategy. Dr Barry attended the committee with her colleague in the Cluain Mhuire Service, Dr Larkin Feeney.
However, speaking to IMT about alcohol, Dr Barry said: “It’s also a money spinner for government in terms of excise but at some point somebody is going to have to make decisions that may have an impact on the exchequer”.
She also called for a ban on advertising alcohol on television before 9 pm and said the issue of alcohol companies sponsoring sport needs to be addressed.
Referring to the European Union, Dr Barry added: “We need to start copying what they are doing in other countries”. The south Dublin based consultant said that self regulation in advertising for alcohol companies does not work.
She explained that in continental European states alcohol cannot be advertised on TV at times when children could be watching. Dr Barry also noted: “Sports sponsorship and alcohol in continental Europe is not a runner”.
Apart from advertising self regulation, Dr Barry also noted other interventions that do not work in reducing harmful or excessive alcohol consumption. Turning to the designated driver idea, Dr Barry said: “There’s a lot of hype. It makes the roads safer but non designated drivers may be consuming a lot more because they have a designated driver and can throw caution to the wind”.
More predictably, Dr Barry also took issue with measures sponsored by the alcohol industry, such as the organisation Mature Enjoyment of Alcohol in Society. She explained: “Unless groups like that come out and say their aim is to reduce the per capital consumption of alcohol… they are not going to have any effect”. She added that, until such groups have budgets similar to those for the advertisement of alcohol products, they are “a real fig leaf and cannot have credibility”.
h4. Highest consumption
Interestingly, Dr Barry pointed out that the type of people who are seeking treatment for alcohol problems is changing. Ironically, while the Republic has one of the highest consumption per capita of alcohol, it also has one of the highest levels of abstention. Twenty three percent of people age 18 years and above do not take alcohol, she said. However, Dr Barry explained that many of these abstentionists are in the older age brackets, and quite a few of them are women.
The psychiatrist then explained how treatment services can be used to understand the changing profile, in terms of gender, of patients seeking help for alcohol problems. “At the present time, if you look at treatment services, we have four times more males than females availing of treatment”. However, she noted that when patients aged 17 years and under are analysed, it turns out that 46 per cent of that age bracket who receive help for problem drinking are female.
Dr Barry also pointed out that when we speak of people who need help for alcohol abuse, this does not just refer to alcoholics. “In the past 30 years or so there is greater recognition of those who are harmful drinkers and hazardous drinkers, who wouldn’t be alcoholics”.
As the presentation to the committee explained, hazardous drinkers consume above the recommended levels of alcohol without apparent harm; while harmful drinkers’ alcohol intake results in physical or mental harm.
So what needs to be done? Dr Barry explained that a cross departmental effort was required, including, the Departments of Health; Finance; Education; Transport; Community, Rural and Gaeltacht Affairs; and Justice. She added that what could be done to start with is to enforce existing legislation and policies, including, for example, liquor licensing laws and the recommendations of the Task Force on Alcohol.
On the medical level, Dr Barry called for intervention facilities for so that when patients turn up in primary care, casualty and general hospital for other treatments, they can also be treated for alcohol misuse. Dr Barry pointed to a Mater Hospital report, conducted in 1999, which showed that out of 1,000 admissions, 300 showed signs of problem drinking but this was only recognised in a small percentage of them and an even smaller number were appropriately referred for treatment. This illustrates “huge missed opportunities,” in the health system, Dr Barry explained.
The psychiatrist explained brief interventions are needed in casualty departments, with better staff recognition of the issue and the option to either refer patients to appropriate healthcare professionals or intervene immediately.
h4. Treated in community
Dr Barry also noted that there is a need in her own sector to ensure that patients with alcohol problems are treated in the community rather than in psychiatric hospitals. She explained that when patients were treated in hospitals and released into the community they go back to the same pressures, hence the significant levels of re-admissions to psychiatric hospitals.
This seems to exemplify another point Dr Barry made – alcohol abuse is not just a concern for the health service to deal with but a problem for many strands of society to deal with together.
About Gary Culliton
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