Search

The evidence for the beneficial health effects of moderate drinking is weaker than commonly perceived. No randomised controlled trials have been done. Observational studies suffer from unavoidable methodological limitations, chiefly from confounding and misclassification. Clinical advice to patients as well as public health recommendations should discourage initiation of alcohol consumption, as well as recommend the reduction of excessive drinking. The absence of health benefits strengthens the the arguments for effective population-level policies, e.g. raising alcohol prices and restricting the physical availability of alcohol.

The main obstacle for people with an alcohol problem to seek help is the stigma attached to alcohol problems and alcohol treatment. Seeking help in primary health care is less stigmatised. Alcohol dependence is mostly of mild or moderate severity and can consequently be managed by non-specialists to a large extent. The 15-method is a structured stepped care model with evidence-based components, where interventions are matched to patient need. The first step, to recognise the impact of alcohol on health, should be mastered by all health professionals.

Moderate drinking has small effects on health. Alcohol-related risks are greatest for young people, and decrease with age. Women are more sensitive than men to the effects of alcohol. Protective effects of moderate drinking are reported for cardiovascular disease, diabetes type 2 and cognitive functioning. However, moderate drinking also involves risks, especially of injuries, violence, foetal damage, certain forms of cancer, liver disease and hypertension. Alcohol consumption should not be recommended for health reasons. Binge drinking, regardless of age, is a medical risk. Health professionals should discuss the pattern of drinking with patients, especially binge drinking, to a larger extent than is usually the case today.

This study examined whether alcohol screening identifies a larger percentage of patients with hazardous alcohol use compared with standard procedures at a surgical emergency unit. Patients were randomised into a study group, where a screening procedure was offered, and a control group, where standard procedures were followed. In the study group 20.9 per cent (using a conservative estimate, 14.8 per cent) of the patients screened positive for hazardous alcohol use, compared with 6.8 per cent in the control group. The screening procedure was particularly effective compared with normal routine in identifying hazardous alcohol use among young women.

In this study drinking habits among primary care patients were investigated as well as their views on discussing life style issues (eating habits, alcohol, smoking and exercise) with their physician. 13% of the men and 5% of the women reported high levels of alcohol consumption. 27% of the men and 11% of the women reported drinking five or more standard drinks more than two times per month. About 70% of the patients had never been questioned about any lifestyle item. A large majority judged lifestyle to be important for their health. 80-90% of all patients thought it important that lifestyle issues were discussed with patients, even if most patients did not perceive a need for this themselves. No differences in this regard were found between high and low consumers of alcohol.