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Alcohol strategy going downhill fast

This is going to be another rant about alcohol, as it’s now several months since the previous one, and I’m starting to get withdrawal symptoms.

This is going to be another rant about alcohol, as it’s now several months since the previous one, and I’m starting to get withdrawal symptoms.

Yesterday, in an attempt to create bonhomie with my physician colleagues, I thought I would visit the acute medical unit to empathise with them on their chaotic lifestyle choice. But I realise that for proper chaos one need not look beyond the emergency department doors.

On the major treatment side, at 9am we had a 16-year-old who, fuelled by drugs and alcohol, had decided to step out of an upstairs window at 5am. Needless to say, he couldn’t fly. Beside him in the admission row were two men with alcohol withdrawal seizures, who were on their umpteenth detox pathway. And beside them was yet another overdose of drugs and booze, the fourth of the night.

Across the floor, an ex-professional in his 50s who had lost his family, his practice and his home to alcoholism, and who frequently fell over because of alcohol-related cerebellar ataxia, was getting his cuts dressed. And a man with a scalp laceration had gone to medical imaging for his 15th brain CT in case this most recent boozy head injury concealed a second cerebral bleed, which would probably not be his last. Or perhaps it would.

I didn’t bother to count the overnight revellers, assaults and ‘unconscious unknowns’ who were waiting to vomit on someone or already had done so. Most were now sorted and discharged, waiting for taxis to take them to friends’ flats, where they could pick up where they had left off. But I did note the kid with his first episode of acute pancreatitis, who will no doubt call again, and the GI bleeder waiting for a surgical bed to be recycled when the endoscopy list got started. 

I checked with my acute physician friend, who had 11 patients in his unit directly linked to alcohol, and with ITU, where a 30-year-old with alcohol-related hepato-renal failure was unlikely to see out the day. So I know that it isn’t just me.

Evidence suggests emergency admissions and alcohol are one and the same, and that as a society we are rolling downhill like a juggernaut without brakes on a path of self-destruction. Perhaps the people who mostly frequent emergency departments have always struggled to control their vodka intake, but it seems to me that this problem has escalated significantly.

No one hears the alarms or the scraping icebergs along the bow as we party through the night while demanding more ice.

Where are the lifebelts? Does the NHS have sufficient lifeboats, or are there just enough to decorate the davits on the upper decks? How much of the drinks industry’s annual £15bn tax yield is directed towards health? Is there an alcohol strategy? Is there?

Charles Lamb is a consultant in emergency medicine

What is the BMA doing?

We are campaigning for a minimum price for alcohol and pressing the UK governments to:

  • Increase and rationalise tax to ensure it is proportional to alcoholic content
  • Reduce licensing hours
  • Ensure licensing legislation is strictly enforced
  • Prevent irresponsible marketing practices
  • Improve labelling, to include alcohol content and recommended daily guidelines
  • Introduce a compulsory levy on the alcohol industry to fund an independent public health body to oversee alcohol-related research
  • Reduce the legal limit for the level of alcohol permitted while driving from 80mg/100ml to 50mg/100ml
  • Ensure the detection and management of alcohol misuse is an adequately funded and resourced component of primary and secondary care
  • Increase and ring-fence funding for specialist alcohol treatment services
  • Lobby for and support the WHO in developing and implementing a legally binding international treaty on alcohol control