Healthy lifestyle is a huge talking point and has become increasingly looked at over the years. Our health is affected by a diverse number of factors, from the genes we inherit from our parents to the climate we live in and the labour we undertake. What we drink and eat, to how much exercise we do, and whether we take drugs or smoke, all affect our health, not solely in terms of life expectancy, but how long we can anticipate living without suffering from chronic diseases. With regard to chronic disease, researchers and health organisations have found an increase in obesity rates in England; In 2008 it was found 25% of women and 24% of men over the age of 16 in England were classified as obese. Also in 2008 39% of adults had a raised waist circumference compared to 23% in 1993 (NHS 2010). The Department of Health envisages that as this continues; by 2010 around 6 million women will be obese compared to 6.6 million men. The data clearly suggests that many people are not taking measures to ensure they lead a healthy life and this can be detrimental both mentally and physically.
However how does alcohol play a role in this? One of the most common questions asked when someone wants to go on a diet or purely want to maintain their weight asks if alcohol can make you fat. Alcohol contains a pronounced amount of sugars and is abundant in calories. This does not necessarily mean someone will become obese if they drink irresponsibly, but this is the first step to eventual health problems. As we know already, sugars are essentially carbohydrates, once absorbed into our blood stream it is immediately used as a source of energy for the muscles and brain. However, sugars in our diet are converted and stored as fat when more calories are ingested than the body actually needs. Heavy drinking over the recommended limit can lead to many health issues not only weight gain, but it can also result in liver damage, arteriosclerosis and diabetes . Social problems can also arise with destroyed relationships, mental problems, increased chances of accidents and stress. Therefore, I would argue that the use of alcohol clearly harms the mind and body, and alcohol should be banned if people are not sensible enough to control their intake. I will look at how alcohol misuse is viewed in society and what guidelines are recommended by the healthcare authorities in order to help people understand how to live healthy lifestyles by controlling their alcohol intake.
In England over 1 million people are dependent (addicted) on alcohol, and millions more consume this substance to a damaging extent. The problems associated with alcohol addiction are extensive. There are affects on physical and mental health, including stroke, a number of cancers, liver cirrhosis, coronary heart disease and high blood pressure. Mental problems that are greatly associated with alcohol addiction range from anxiety and depression, to additional drug misuse and nicotine dependency.
In the community, Pharmacists play a major role in maintaining the general health of their patients. The government White Paper 'Equity and Excellence - Liberating the NHS' from the department of health published in July 2010 explained what impact community pharmacists can potentially have on public health. How this relates to alcohol misuse is very important and must be looked at from a healthcare professional perspective as well as healthcare models. The white paper states that pharmacists have a key role in preventing diseases, prolonging life and promoting, protecting and improving health in the society. This is best achieved by working within a multidisciplinary team and forming partnerships with those that contribute to health of the population. How this impacts on public health is that the patient will be the central point of focus, where shared decision making and greater control will be influential in the improvements of the patient's health. Working as a team within the NHS is crucial for the wellbeing of our patients and providing support to help patients suffering from alcohol dependence.
How we measure the amount of alcohol in our alcoholic drinks is by a measure of units, where 10ml of pure alcohol is equivalent to one unit. The NHS recommends for men to have no more than 3-4 units per day and no more than 2-3 units per day for women. If this amount is regularly exceeded on a daily basis you are placing your health at risk. As well as the health issues raised above there are more notable concerns that pharmacist are in a position to intervene. Psychiatric problems such as alcohol dependence syndrome, anxiety, depression are serious conditions which arise from dangerous high levels of drinking. In England studies were done to suggest that in 2007, 16% of women and 33% of men were classified as hazardous drinkers. Over 150,000 prescription items of drugs for the treatment of alcohol dependency was reported in 2009. This value showed a 12% increase since 2008 and a massive 46% increase in prescription drugs for alcohol dependency since 2003 (NHS 2010). As the data indicates there is definitely an increase in people risking their health when it comes to alcohol use. But what can be done to ensure that this is something that can be controlled? We cannot simply ban the use of alcohol, even though it is a very good idea! However measures have been taken and it depends on the willingness of our patients to take on board what advice we give them.
The NHS clearly sets out guidelines that define the different types of alcohol misuse:-
Hazardous drinking is defined as when someone drinks over the recommended weekly limit, for the case of men it is 21 units and 14 units for women. Binge drinking also contributes to hazardous drinking; this involves drinking unnecessary amounts of alcohol in a short period of time. How this affects your health relates to you becoming more aggravated and less reluctance to argue or fight, therefore increasing the chance of you becoming involved in an accident and taking part in illegal or risky behaviour when drunk.
Harmful drinking is perhaps the most dangerous and involves a person drinking over the recommended weekly amount when they have experienced previous health relating problems directly linked to drinking alcohol. Problems such as depression, inflammation of the pancreas are obvious and most recognised straight away. However as mentioned previously aggravating problems such as high blood pressure and heart disease are also issues. Problems working with others, difficulties at home with family and friends can result from harmful drinking. Finally, dependant drinking is when a person becomes unable to function or feels that without alcohol there is no meaning to their life (in extreme circumstances). Alcohol is both psychologically and physically addictive and depending on the level of craving a person can experience withdrawal symptoms if they are cut off from a supply of alcohol. Physical withdrawal symptoms include sweating, nausea, hand tremors and seizures. Psychological withdrawal symptoms include depression, irritability, anxiety, and the inability to sleep (insomnia).
How can patients be treated medically within a multidisciplinary healthcare team?
Advice and counselling should be given at all costs. Patients can be referred to a short counselling session lasting around 10 to 15mins known as a brief intervention and usually entails a series of steps. Long and short term risks are mentioned on a one to one basis as each person differs in the amount of alcohol consumption they intake and their willingness to change their drinking habits. A drink diary is a basic but effective method in ensuring an accurate record is made of the amount of units of alcohol a person drinks per week to see if this can be gradually lowered over time. Asking patients whether they totally want to stop drinking is always good; however as with all things, for instance smoking, it is a difficult procedure and involves dedication and hard work. Depending on the level of toxicity you may refer patients for detoxification. Patients may find that their level of dependency is low to moderate and patients should be able to detox at home without the need for medication. However, there are compliance issues and regular counselling and monitoring must be pursued. If, however, an individual's level of dependency is moderate to severe and drinking 20 units of alcohol or more a day then detox and regular medication is advisable.
Along with the general medical healthcare system, there are various health models that support the notion that can cause someone to be more reluctant to drink than normal. How each model perceives the responsibility of an individual's health depends on what is being taken into perspective. These models are designed to look at aspects of particular subjects from a number of perspectives and to distinguish the reasons behind it and work to some sort of conclusion. There are a number of health models that relate to alcohol misuse, and I will relate these models to how someone can affect their health through excessive drinking.
The biopsychosocial model outlines the psychological (emotions, behaviours and thoughts) and biological factors that play a substantial part in human functioning in the context of health. There is a strong prominence on the correct functioning of the human body as a result of a successful link between the mind and body. There has to be a balance between the body's needs and what the mind really needs. This sort of relationship between mind, body and spirit or the mental, physical and spiritual aspects of an individual is the definition of holistic health. Traditionally we may either treat mind and ignore the body, or treat the body but ignore the mind. Neither addresses the spiritual aspect. Both options either treat symptoms with surgery or drugs rather than considering what initiated the symptoms. Subsequently, we can argue that the responsibility is greatly emphasised on the individual to maintain their own health. Alcoholics have therefore put the blame on themselves. This condition that they have succumbed to is a result of poor lifestyle over an extended period of time.Had they been more self-aware and had more self-control, abiding to the recommended guidelines of units per day/week, then they would not be in this situation of being over dependent on alcohol, and causing deterioration in their health. We cannot only take into account the psychosocial model that contributes to alcohol abuse. Using evidence based healthcare we can aim to use accurate and up to date evidence gained from tested scientific methods and apply them to our clinical decision making. Evidence clearly states that excessive drinking and poor lifestyle can lead to ill health and further medically related problems. Evidence based healthcare not only implies it is their own responsibility but in addition that alcoholics should change their ways, for their own benefit and others around them.
Alcoholism can be viewed as a significant social problem. This not only has an impact on the individual and their family but additionally on society. How society is affected is a result of a high incidence of alcoholism in the form of health issues, medical expenses, days missed off work, drunk driving causing devastation not only to themselves but others around them and so on. As mentioned above alcoholism can be viewed from a number of perspectives but the most significant one mentioned is the medical model and how medical treatment can be implemented to treat this disease. However before you treat something you must look at the cause first and not only view the individual but what influenced the individual to this condition. This model looks at society as a whole and research has concluded that there are factors that can cause predisposition to alcoholism. Cultural and demographic factors are also hugely influential. People in deprived areas have been found to be associated with a higher chance of hazardous drinking. For instance, Blackpool, which is a prominent seaside resort in the UK, has gone into an abrupt economic decline and now heavily relies on hen and stag parties to maintain it as a viable annual destination. Due to this unfortunate turnaround it has a greater than national average alcohol-related morbidity and mortality rate, being most concentrated in the deprived town areas.
The World Health Organisation (WHO) described 'health' in 1948 as: "health is a state of complete mental, physical and social well-being, and not purely the lack of disease or infirmity." The social model of health explains this concept through the individual and their community and appreciates this as a result of interacting and complex economic, social, personal and environmental factors. Observation of this model shows that the determining factors of health are far more diverse and extensive in essence than those found in the biopsychosocial model. Because of these contributing elements, the prospective for allocating responsibility for ill-health is far greater. In essence the basic assumptions that are made relies on a human being is not seen as a systematic combination of biophysical utilities but as an organistic entity.
One way of perceiving this model is identifying why people drink more at home. Drinking has become increasingly popular at home than in more social places such as restaurants, pubs, clubs and cafes. The off-trade intake of alcoholic drinks is estimated to rise by 15%, which is £12.3 billion in value from 2008-2010 alone, with women being the significant growth factor in this trade. Research done has shown over the years that the majority of drinking takes place outside of licensed premises but there is lack of research into reasons why adults elect to drink in non-licensed premises. Most research to date has mainly focused on younger adults in this respect and concluded that associated drinking in places such as parks carries high risk. It is thought that convenience and cost are two key variables why people opt to drink at home, this may be more so a benefit for parents with younger children. Certain social events such as barbeques and family parties have become increasingly linked to home drinking. Research has shown that older people over the age of 30 with young families have become reluctant to visit town centres as they are alleged to be overwhelmed by younger binge drinkers.
As mentioned above, social influences play a major role in the life styles that someone takes. I have mentioned one of these factors through home drinking. Although this aspect may be marginal to someone drinking more than normal, there are other social factors that can be perceived through the sociological model. Medical conditions such as depression and stress can come about from unfortunate circumstances that can greatly affect someone's health. Some people drink for escapism to forget or avoid their anxieties and problems. Thus, this can be a very destructive way of drinking that may eventually cause that person to alienate themselves from family and friends, and begin the prospect of serious physical and mental health problems. However if you are in such an environment where you experience certain things that everyone seems to be doing, then you automatically believe it is the normal thing to do, this does not necessarily involve drinking, but smoking, drugs misuse, social activities, such as clubbing, partying could be prominent in that particular community. In terms of drinking this can be damaging and then as a healthcare professional would you place the blame solely on the individual for their ill health, or take note of the circumstances that have caused it and rectify those concerns instead? This is how the sociological model explains the notion of alcoholism. Unlike the Biopsychosocial model, where I have explained that physical and psychological effects can cause damage to health through drinking, we place some of the blame on the patient stating that "you are responsible for your own health, so you must do something to change."
From the standard medical view point to both the biopsychosocial and sociological model it is evident that alcoholism is a disease that takes control of an individual and causes them to deteriorate over time. How this is overcome each model has their own angle, either identifying the part of the body that has malfunctioned and must be treated with medication or through lifestyle changes, advice and counselling. As a future pharmacist is evident that we must have an open mind of how we treat someone. Patients are not machines where we can simply "open and change damaged part." It is important to realise there are many factors interlinked and entwined that someone subjected to ill health is scrambled in and we must slowly but surely help to free them of these.