‘We need to talk about your drinking’

3 minute read

Raising alcohol use with a patient can be tricky, but it pays to make the time


Newly established links between cancer and drinking could be a prompt for doctors to initiate discussions about alcohol, Australian research says.

Study author Dr Emma Miller, an epidemiologist at Flinders University, said the developing knowledge of alcohol’s ties to cancer offered a useful hook to broach the topic.

“Given the general carcinogen that alcohol is now known to be, and its very strong links with particularly prevalent cancers such as breast cancer in women and bowel cancer in men, this may actually be an opportunity for physicians to destigmatise that whole discussion,” she said.

“Of course, once you are talking about that link that the patient would probably not be aware of, you can be talking about the links with the many other chronic diseases which are associated with regular use of alcohol,” Dr Miller said. “This includes cardiovascular disease and depression, which are probably the two most common reasons people go to the GP.”

A survey of almost 900 GPs across Australia found the most commonly cited barrier to routinely asking about alcohol was a lack of time.

However, this was more frequently suggested as a barrier by doctors who also said they were less confident in managing alcohol issues, and were worried about provoking a negative response in patients.

On the other hand, GPs who were confident in their ability to assess and manage alcohol issues were less likely to believe lack of time was a block to discussing alcohol with patients.

“That gave a little bit of hope that if you could come up with an acceptable way to routinely and easily embed screening of alcohol problems in general practice, that it could be done. It isn’t a material lack of time,” Dr Miller said.

The research is part of a larger study into the response of Australians to warnings about cancer on alcohol products.

Preliminary findings showed a very strong message that people wanted to hear about alcohol and cancer from their doctors, Dr Miller said.

There was also the perception that perhaps patients would be averse to hearing about alcohol if it was unrelated to the condition they presented with.

But this perception had not been borne out by previous research, which had largely suggested patients were supportive of GPs asking about alcohol use, particularly patients with diabetes, oesophageal disease, hypertension and depression, the authors wrote.

Nevertheless, other research suggests raising alcohol use may sometimes be seen as judgemental and stigmatising.

Alcohol, which is responsible for 3% of the country’s total burden of disease, is causally related to more than 60 different health conditions.

BMJ Open 2016; online 1 December

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