DOCUMENT RESUME SP 036 993 ED 400 257 Anderson, Peter AUTHOR Alcohol and Primary Health Care. WHO Regional TITLE Publications, European Series No. 64. World Health Organization, Copenhagen (Denmark). INSTITUTION Regional Office for Europe. ISBN-92-890-1328-1; ISSN-0378-2255 REPORT NO PUB DATE 95 NOTE 98p. WHO Regional Office for Europe, Office of AVAILABLE FROM Publications, Scherfigsvej 8, DK-2100 Copenhagen 0, Denmark. Research/Technical (143) PUB TYPE Reports Tests /Evaluation Instruments (160) MF01/PC04 Plus Postage. EDRS PRICE Adults; *Alcohol Abuse; 'Alcoholism; Family Health; DESCRIPTORS Family Involvement; Foreign Countries; *Health Education; Intervention; *Primary Health Care; *Public Health; Special Health Problems *Alcohol Wellness; Europe; *Health Behavior IDENTIFIERS ABSTRACT The European Alcohol Action Plan stresses that health care systems, traditionally involved in the management of alcohol problems, must play a greater role in the detection and prevention of alcohol-related harm. Primary health care is seen as an important setting for identifying individuals at risk from heavy drinking and helping them to reduce consumption. It is also the major supporter of families and self-help groups, and acts as an advocate of public health for local communities. The book discusses strategies that can be adopted by primary health care providers in their everyday work with individuals and families, and examines the role of primary health care in providing interventions for hazardous and harmful alcohol consumption. The 14 chapters of the book cover: (1) the (2) the risk from alcohol; potential of primary health care; (3) (5) health (4) screening; effectiveness of brief interventions; (7) barriers to implementation; education advice; (6) intervention; (9) education and training; (10) family (8) packages and protocols; (12) alcohol policy; (13) (11) community action; and friends; targets; and (14) conclusion. Appendices include the "Alcohol Use Disorders Identification Test" (AUDIT) questionnaire and "Health Plan for Catalonia." (Contains 72 references.) (ND) *********************************************************************** * Reproductions supplied by EDRS are the best that can be made from the original document. *********************************************************************** Alcohol and primary health care U.S. DEPARTMENT OF EDUCATION Othce of Educational Research and Improvement EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC) This document has been reproduced as received horn the person or caganrzation originating it 0 Minor changes have been made to improve reproduction Quality "PERMISSION TO REPRODUCE THIS MATERIAL HAS BEEN GRANTED BY Points of new or opinions slated in this docu- rie ment do not necessarily represent official OERI position or policy /,,Ce t.:-/s. TO THE EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC)... AVAILABLE BEST COPY 2 WHO Regional Publications European Series No. 64 Publication Series of the European Alcohol Action Plan Peter Anderson Evaluation'and monitoring of action on alcohol, by and Juhani Lehto. Approaches to alcohol control policy, by Juhani Lehto. Juhani Lehto. The economics of alcohol policy,by by Marjatta Montonen. Alcohol and the media, by Bruce Ritson. Community and municipal action on alcohol. by Peter Anderson. and primary health care, ,Alcohol by Nick Heather. Treatment approaches to alcohol problems. ie Anderson. Young people and alcohol, drugs and tobacco, by Kel I Marion Henderson, /1/coho/ and the workplace, by Graerne Hutcheson and John Davies. The World I lealth Organization is a specialized agency of the United Nations with primary responsibility for international health matters and puhlic health. Through this Organization, which was created in 1948. the health professions of over I 80 countries exchange their knowledge and experience with the aim of making possible the attainment by all citizens of the world of a level of health that will permit them to lead a socially and economically productive life. The WHO Regional Office for Europe is one of six regional offices throughout the world. each with its own programme geared Itt the particular health problems of the countries it serves. The European Region embraces some 850 million people liv- ing in an area stretching from Greenland in the north and the Mediterranean in the south to the Pacific shores of Russia. The European programme of WHO therefore concentrates both on the problems associated with industrial and post-industrial soci- ety and on those faced by the emerging deMocracies of central and eastern Europe and the former Soviet Union. In its strategy for attaining the goal of health for all the Regional Office is arranging its activities in three main areas: lifestyles conducive to health. a healthy environment. and appropriate services for prevention. treatment and care. The European Region is characterized by the large number of languages spoken by its peoples, and the resulting difficulties in disseminating information to all who may need it. Applications for rights of translation of Regional Office hooks arc there- fore most welcome. 3 World Health Organization Regional Office for Europe Copenhagen Alcohol and primary health care by Peter Anderson Alcohol, Drugs and Tobacco Unit, WHO Regional Office for Europe WHO Regional Publications, European Series, No. 64 4 Text editing by Frank Theakston WHO Library Cataloguing in Publication Data Anderson, Peter Alcohol and primary health care / by Peter Anderson prevention & control 2.Primary health care 1.Alcoholism 3.Consumer participation 4.Europe I.Title II.Series (WHO regional publications. European series ; No. 64) ISBN 92 890 1328 (NLM Classification: WM 274) ISSN 0378-2255 The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applica- tions and enquiries should be addressed to the Office of Publications, WHO Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen 0, Denmark, which will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. ©World Health Organization 1996 Publications of the World Health Organization enjoy copyright protection in accord- ance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. The designations employed and the presentation of the material in this publica- tion do not imply the expression of any opinion whatsoever on the part of the Secre- tariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its fron- tiers or boundaries. The names of countries or areas used in this publication are those that obtained at the time the original language edition of the book was prepared. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omis- sions excepted, the names of proprietary products are distinguished by initial capital letters. The views expressed in this publication are those of the author and do not nec- essarily represent the decisions or the stated policy of the World Health Organization. PRINTED IN FINLAND 5 Contents Page Introduction 1 The potential of primary health care 4 1. The role of primary health care 7 The risk from alcohol 2. 10 Alcohol and physical harm 10 Alcohol and social harm 13 Alcohol and violent harm 13 Size of the risk 14 Distribution of risk 14 Effectiveness of brief interventions 3. 16 Research results 17 Screening 4. 21 Recognizing hazardous alcohol consumption 22 Recognizing harmful alcohol consumption 24 Health education advice 27 5. Advice to individuals 27 Advice to the public 30 Intervention 6. 31 Intervention for hazardous alcohol consumption 31 Intervention for harmful alcohol consumption 33 Barriers to implementation 39 7. Overcoming barriers 40 Phase III WHO collaborative study 43 Packages and protocols 48 8. Packages 48 Protocols 48 iii Education and training 9. 51 Educational principles 51 Educational and training models 52 Training course on helping people change 54 Competencies and training recommendations 54 10. Family and friends 57 Empowering family members and friends 57 The family as health-promoting agent 59 11. Community action 60 Health promotion and disease prevention 61 Undertaking a community project 65 Involving primary health care 67 WHO demonstration and evaluation project 70 12. Alcohol policy 72 Elements of alcohol policy 72 13. Targets 76 Standards, targets and indicators 77 14. Conclusion 80 References 82 Annex 1 87 Annex 2 89 7 iv Introduction On a European scale, drinking alcohol results in suffering and costs of enormous proportions, which have an impact on the health and wel- fare of men and women, children and adults, the poor and the rich, those who do the drinking and those who suffer from the drinker's behaviour (1). Alcohol-related problems have many causes, arise in various situations, and affect different types of people. The response to these problems therefore needs to be comprehensive, involving public pol- icy, community programmes and action at the primary health care level. Primary health care providers include a wide range of different professional groups. In this book, they are defined as doctors and nurses working in primary health care settings. In 1980, a WHO expert committee (2) stressed the need for effi- cient methods to detect people consuming harmful quantities of alco- hol before the health and social consequences became pronounced, and called for the development of strategies that could be applied with a minimum of time and resources in primary health care settings. These recommendations came at a time when efforts to imple- ment a public health approach to alcohol-related problems had been initiated in a number of countries. Other reasons for the growing in- terest in alcohol screening and brief intervention were: the effective- ness of various behavioural change techniques for both excessive al- cohol consumption and other areas of lifestyle, the need to conserve health care resources, the appeal of early intervention as a means of preventing more severe alcohol-related problems and alcohol depend- ence, a recognition of the need to broaden the base or focus of defini- tions and approaches to alcohol problems (3), and evidence to suggest 1 8 Alcohol and primary health care that the burden of illness imposed on society by hazardous or harmful alcohol consumption is greater than that imposed by alcohol dependence. In 1992, resolution EUR/RC42/R8 of the WHO Regional Committee for Europe strongly endorsed the European Alcohol Ac- tion Plan (4). It urged Member States: to review and, if necessary, reformulate their alcohol policies to ensure that they were compre- hensive and broadly in line with the principles set out in the Action Plan; to ensure effective implementation of such policies in order to prevent the health risks and socioeconomic problems often associated with alcohol consumption, recognizing the importance of multisectoral action and the major role of local communities; and to develop compre- hensive policies and programmes for the prevention and management of alcohol-related problems in the context of primary health care. The European Alcohol Action Plan stresses that health care sys- tems, traditionally involved in the management of alcohol problems, must play a greater role in the detection and prevention of alcohol- related harm. Primary health care is seen as an important setting for identifying individuals at risk from heavy drinking and helping them to reduce consumption. It is also the major supporter of families and self-help groups, and acts as an advocate of public health for local communities. A strategy based on primary health care can also com- plement population-based initiatives (/). In their study of the general practitioner's role in detecting and managing alcohol problems, Thom & Tellez (5) include the following statement from one general practitioner: One of the things I don't do is ask too many questions because I don't want to uncover a whole lot of things I can't deal with. So my technique sounds awful but it is to wait until something comes to my attention generally. I am not going hunting out problems I don't know how to treat. I could spend hours and hours every day trying to deal with it. Now if it were obvious how I could deal with it effectively then I might go looking for a few patients. It is hoped that this book goes some way to answering the ques- tion of how the harm done by alcohol use can be prevented and man- aged in primary health care. Much of the book discusses strategies 9 2 Introduction and approaches that can be adopted by primary health care providers in their everyday work with individuals and families. It recognizes that primary health care providers have a public health role to play, and outlines the opportunities to participate in community action and to advocate for healthy public policy on alcohol. The book covers the role of primary health care in providing in- terventions for hazardous and harmful alcohol consumption. It does alcohol not discuss the assessment or treatment of individuals with dependence or the relationship of primary health care to other treat- (6,7). ment systems, as these have been recently discussed elsewhere Although the primary concern here is alcohol, an integrated ap- proach to prevention should be encouraged, within a common strategy of health promotion. Preventive action on alcohol should be inte- grated with that on other lifestyle issues, such as tobacco use, diet and physical activity. Indeed, much of what is written about alcohol can be applied to other lifestyle issues. 0 3