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Society and culture: Drinking alcohol is highly culturally ingrained in British society.  Whilst alcohol abstention may ultimately be best choices for promoting overall health and wellbeing, this may not be a practical goal.  As such, nurses need to encourage moderation, and educate patients how, if they do choose to drink, they can do so safely.  This can be through measures such as encouraging patients to limit how much they drink, encouraging patients to drink more slowly, drinking with food, alternating with water or non-alcoholic drinks (information from NHS choices)

Aggression: According to drinkaware and research by the home office, alcohol is linked to aggression.  This can arise in people who are not normally aggressive but can still have long lasting social implications.  For example, If a nurse was sighted displaying signs of aggression whilst being drunk, s/he would likely have a fitness to practice investigation and risk losing his/her job.

Financial: Excessive alcohol consumption is expensive.  The average price for a pint of beer is £3.60.  This can be detrimental in particular to those who have already have anxieties about money.

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Physical effects of alcohol constumption

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Physical effects of alcohol constumption

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Liver damage: Prolonged alcohol misuse can cause serious and irreversible damage to the liver.  https://www.nhs.uk/conditions/alcohol-related-liver-disease-arld/

Cancer: The less alcohol you drink, the lower your risk of cancer.  Alcohol is known to cause 7 types of cancer, including breast, mouth and bowel cancer  http://www.cancerresearchuk.org/about-cancer/causes-of-cancer/alcohol-and-cancer

Obesity: A standard glass of wine can contain as many calories as a piece of chocolate, and a pint of lager has about the same calorie count as a packet of crisps.   Alcoholic drinks account for 11% of the UK population’s daily intake of added sugar http://www.drinkaware.co.uk/alcohol-facts/health-effects-of-alcohol/effects-on-the-body/alcohol-and-sugar/

Diabetes:  Due to alcohol’s high sugar content, it can be very dangerous for those with diabetes to drink in excess.  It also makes hypoglycemic medications less effective https://www.drinkaware.co.uk/alcohol-facts/health-effects-of-alcohol/effects-on-the-body/alcohol-and-sugar/

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Self assessment tool - this helps patients see whether or not they are drinking in excess: https://www.drinkaware.co.uk/selfassessment

Drink aware track app - this allows patients to track their drinking habits and https://www.drinkaware.co.uk/tools/app/

Alcohol cessation book by international best selling writer of psychological dependence:  Allen Carr  - The Easy Way to Quit Drinking.

These resources encourage patients to be proactive in their health, promoting independence and autonomy in the health promotion process  (as per NMC code).

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Charitable organisations in South Wales 

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Charitable organisations in South Wales 

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http://www.drinkwisewales.org.uk/about-us/

Drink wise Wales is a national charity who's 'goal is to improve people’s lives through reducing the harm caused by alcohol.'
The long term aim of Drink wise Wales is to change the drinkining culture in Wales. This charity would be a good form of support for people who suffer from alcoholism, it provides information in addition to resources to help people who suffer.

https://www.alcoholconcern.org.uk/Pages/Category/alcohol-concern-cymru

Alcohol concern is another charitable organisation who works closely to the Welsh Government to encourage people to have a good relationship with alcohol. This paticular charity runs multiple campaigns e.g alcohol awareness week, dry January, advertising and drink driving. Alcohol concern also have support available wether it be in the workplace or out in the community.

http://change4lifewales.org.uk/adults/alcohol/?lang=en

Change4life Wales provides tips and infromation on how people can moderate their drinking intake. The charity does this by promoting the possible alternatives to drinking, for example taking the dog for a walk, going for a walk or starting a new hobby. Change4life Wales also have a 'get more support' section which would refer a service user to websites such as drink wise Wales, drink aware and alcohol concern as these charities provide more support.

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Psychological effects of alcohol consumption

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Psychological effects of alcohol consumption

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Cause and effect: Alcohol can not only negatively impact mental health, but excessive drinking can be caused by underlying mental health issues.  Nurses need to be mindful of this.  Many people ‘self-medicate’ through drinking, in order to temporarily alleviate feelings of anxiety, depression, emotional distress etc.  As such, it is often not enough to promote drinking in moderation without addressing the potential underlying issues which lead to excessive alcohol consumption.   https://www.drinkaware.co.uk/alcohol-facts/health-effects-of-alcohol/mental-health/alcohol-and-mental-health/

Can worsen mental health: Nurses need to inform patients that whilst drinking may provide a temporary relief to negative mental and emotional states, studies show that excessive drinking is ultimately detrimental to mental health and wellbeing.  Alcohol alters your brain chemistry which can affect our thoughts, feelings and actions. Alcohol interferes with neurotransmitters in the brain making it ultimately more difficult to deal with symptoms of anxiety, despite the fact it may initially help you feel relaxed. https://www.drinkaware.co.uk/alcohol-facts/health-effects-of-alcohol/mental-health/alcohol-and-mental-health/

Suicide: Alcohol can promote impulsive behaviour, so nurses need to be aware of this if e.g. a patient is drinking to excess whilst struggling with depression, as they may be at greater risk of suicide.  https://www.drinkaware.co.uk/alcohol-facts/health-effects-of-alcohol/mental-health/alcohol-and-suicidal-thoughts/

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The Role of the Health Visitor in Moderating Alcohol Consumption

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The Role of the Health Visitor in Moderating Alcohol Consumption

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http://www.nchk.org.hk/filemanager/en/pdf/health_promotion_e.pdf

The health of an individual is largely determined by factors including shelter, food, education, health and social care services within area etc.  Therefore, health promotion nurses would need to take this into consideration before informing the initial assessment to ensure that the plan they form for the individual meet their individual needs and provides opportunity to gain knowledge and access to services available regarding alcoholism. alcohol consumption.

> What is it you understand about your present health condition?
> Have you received any previous help?
> Do you understand this? Is there anything you need me to go through?

. They focus on the stimulation of an awareness of health needs regarding alcohol consumption. and the facilitation of health enhancing activities I.e alcohol support groups.

Substance misuse can also have negative impacts on parenting. This includes time spent away from children, lack of energy as well as prioritising the addiction of alcohol over the needs of the child. Health promotion nurses work in partnership with families, friends etc in order to create a supportive environment.

Additionally, there are further negative outcomes for children I.e fetal alcohol spectrum disorder, behaviour problems, neonatal abstinence syndrome.
https://www.magonlinelibrary.com/doi/abs/10.12968/John.2015.3.7.374

To address this, there are family support nurses and screenings as part of the Healthy Child Wales Programme.
The HCWP offer starts enhanced and intensive interventions to those children and families with increased level of need.

Investments in early years is crucial - social, educational and health outcomes improved (The Black Report 1980)
https://www.sochealth.co.uk/national-health-service/public-health-and-wellbeing/poverty-and-inequality/the-black-report-1980/

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Behavioural Change- Encouraging individuals to adopt healthy behaviours and adopt a healthier lifestyle as defined by the health promoter (nurse). This can be through various resources - online applications, leaflets. Important to ensure the individual is able to understand the information they are being given.

Persuasive Communications (Clarke 1999, Nursing Standard) Characteristics of the communicator are important (trustworthy? credible?) Requires a large amount of contact time as communication is more assured. This is something nurses may not have with every individual but the importance of building therapeutic relationships with individuals is still important.

Motivational interviewing (Health Psychology Article) - Reflective listening and helps to establish discrepancies. The individual needs to establish trust in the health promoter. Non- judgemental, encouraging and empathetic.

Educational Approach- Health promoter is able to inform the individual with knowledge and understanding of how lifestyle choices can affect their health. Health promoter is also able to explore the individuals values and attitudes through this approach and the individual has free choice after being oven the information. Information must be evidence based to ensure credibility - leaflets, posters, guides and suggesting alternatives.

Empowerment- Helps the individuals to identify their own concerns and needs and attitudes towards alcohol consumption.

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Within this epidemiological data it states that Scotland has the highest alcohol related mortality rates, however has seen the largest decrease in deaths.
Is this stating that where you live has an impact on the amount of alcohol that is consumed? This expanding on the Dahlgren and Whitehead Model of attributes that can impede ill health.

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All data related to Alcohol-specific deaths in the UK: registered in 2016 - Office for National Statistics

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These data results show that cases of death caused by alcohol are more affluent in the age bracket 55 - 64.
"Males accounted for approximately 65% of all alcohol-related deaths in the UK in 2014."
Additionally stating that males made up the larger proportion of mortality rate in accordance with alcohol.

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7% of adults in England regularly drink over the Chief Medical Officer's low-risk guidelines, and 2.5 million people report drinking over 14 units on their heaviest drinking days.

In 2016, 21% of the population report not drinking at all and overall consumption has fallen by around 18% since 2004.

In the UK, in 2015 there were 8,758 alcohol-related deaths (around 14 per 100,000 people). The mortality rates are highest among people aged 55-64.

In England, there are an estimated 595,000 dependent drinkers, of whom only around 100,000 are currently accessing treatment.

Alcohol misuse is the biggest risk factor for death, ill-health and disability among 15-49 year-olds in the UK, and the fifth biggest risk factor across all ages.

Alcohol harms are estimated to cost the NHS around £3.5 billion annually.

While the price of alcohol has increased by 36% since 2005, it remains 60% more affordable than it was in 1980.

Alcohol is a causal factor in more than 60 medical conditions, including: mouth, throat, stomach, liver and breast cancers; high blood pressure, cirrhosis of the liver; and depression

In the UK in 2014-5, there were an estimated 1.1 million hospital admissions related to alcohol consumption where an alcohol-related disease, injury or condition was the primary reason for hospital admission or a secondary diagnosis. In the same period there were 339,000 admissions for conditions directly caused by alcohol.

Males accounted for approximately 65% of all alcohol-related deaths in the UK in 2014.

The alcohol-related mortality rate of men in the most disadvantaged socio-economic class is 3.5 times higher than for men in the least disadvantaged class, while for women the figure is 5.7 times higher.

In England and Wales, 63% of all alcohol-related deaths in 2014 were caused by alcoholic liver disease.

Liver disease is one of the few major causes of premature mortality that is increasing, and deaths have increased by around 40% in a decade.

The number of older people between the ages of 60 and 74 admitted to hospitals in England with mental and behavioural disorders associated with alcohol use has risen by over 150% in the past ten years, while the figure for 15-59 years old has increased by 94%

Treatment

Of the estimated 595,000 dependent drinkers in England, around 145,000 were in treatment in 2015, a fall of about 5% on the previous year. Of these, around 60% successfully completed treatment.

The median age for people in alcohol treatment is 45.

In 2015, 196,000 prescriptions for drugs to treat alcohol misuse were prescribed, costing around £3.9 million. This is double the number in 2005.

Approximately 52% of clients starting treatment were self-referrals. 17% were referrals from general practitioners (GPs), with other referrals from hospitals, social care and other services.

Crime

Victims believed the offender(s) to be under the influence of alcohol in over half (53%) of all violent incidents, or 704,000 offences.

64% of stranger violence, and 70% of violent incidents in the weekends, evenings and night are alcohol-related.

Alcohol-related crime in the UK is estimated to cost between £8bn and £13bn per year.

In 2015, there were over 8,000 casualties of drink driving accidents in the UK in 2013, including 220 fatalities and 1,160 serious injuries.

Drinking Behaviour

Since 2005, the overall amount of alcohol consumed in the UK, the proportion of people reporting drinking, and the amount drinkers report consuming have all fallen. This trend is especially pronounced among younger drinkers.

8 million people drank over 6 units (for women) or 8 units (for men) on their heaviest drinking day.

77% of the highest earners report drinking in the previous week, compared to less than 45% of the lowest earners.

People in the South West of England are the most likely to report drinking in the last week, while those in the North East are most likely to binge when they do drink.

Young People

In 2014, 38% of school pupils (aged 11-15) said that they had drunk alcohol at least once, down from 62% in 1988. Of these, 8% of 11 year-olds reporting ever having drunk alcohol, compared to 69% of 15 year-olds.

1% of 11 year-olds and 18% of 15 year-olds report drinking in the previous week. Mean consumption for 14 year-olds who report drinking in the previous week is 11.3 units.

You can download the statistics here.
Sources
Health and Social Care Information Centre (2017). Statistics on Alcohol, England, 2016. HSCIC and ONS.

Office for National Statistics (2017). Adult drinking habits in Great Britain: 2005 to 2016.

Office for National Statistics (2015). Violent crime and sexual offences - alcohol-related violence. ONS.

Office for National Statistics (2017). Alcohol-related deaths in the UK: registered in 2015.

Public Health England (2017). Local Alcohol Profiles for England - Statistical Bulletin, March 2017.

Public Health England (2016). Adults Substance Misuse Statistics from the National Drug Treatment Monitoring System (NDTMS): 1 st April 2015 to 31 st March 2016.

Fuller, E. ed. (2015). Smoking, Drinking and Drug Use Among Young People in England in 2014. HSCIC and

Burton, R. et al (2016). The Public Health Burden of Alcohol and the Effectiveness and Cost-Effectiveness of Alcohol Control Policies: An Evidence Review.

ROSPA (2017). Road safety factsheet: drinking and driving, March

Pryce, R. et al. (2017). Estimates of alcohol dependence in England based on APMS 2014, including estimates of children living in a household with an adult with alcohol dependence: prevalence, trends, and amenability to treatment. University of Sheffield, Kings College London and Public Health

Siegler, V. et al. (2011). Social inequalities in alcohol-related adult mortality by national statistics socio-economic classification, England and Wales, 2001-3. Health Statistics Quarterly

British Beer and Pub Association (2016). Statistical Handbook, 2016.

Verne, J. (2014). Liver disease: a preventable killer of young adults. PHE Public Health Matters, 29 th September 2014.

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7% of adults in England regularly drink over the Chief Medical Officer's low-risk guidelines, and 2.5 million people report drinking over 14 units on their heaviest drinking days. In 2016, 21% of the population report not drinking at all and overall consumption has fallen by around 18% since 2004.

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What professional and ethical considerations would a nurse need to be aware of when supporting a person with this need? 

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What professional and ethical considerations would a nurse need to be aware of when supporting a person with this need? 

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- Respect their autonomy & their right to refuse support - can only advise and encourage the patient
Respect the person's self-determination
- Patient centred care = their goals & outcomes, treatment & information given to them
- Consider showing beneficence & acting in a judgemental & maleficence manner & to ensure veracity
- Consider their approach to the patient = motivational interviewing, empower & encourage the patient, being persuasive & motivating

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Principles of nursing practice | Royal College of Nursing

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The eight Principles are used to describe what everyone, from nursing staff to patients, can expect from nursing.

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What does the NMC code include in relation to these issues?

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What does the NMC code include in relation to these issues?

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E.g.
- Putting care and safety first
- Respect rights, dignity, privacy & confidentiality
- Take action if they have concerns about the care and safety of patients
- Act with honesty and integrity at all times
- Pay attention to your wellbeing, treatment & care
- Help you to access the care and support that you need
- Listen & take notes of concern

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This report shows the prevalence of inequalities in health in correlation with socioeconomic surroundings; whether they are affluent or destitute areas.
Within the report it is apparent that the lower the socioeconomic group the higher the hospital admissions for alcohol related concerns/deaths

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What other multidisciplinary team members might a nurse usefully refer the person to for health promotion support with this issue?

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What other multidisciplinary team members might a nurse usefully refer the person to for health promotion support with this issue?

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-      GP = for support on joining a support group e.g. alcohol anonymous

-       GP & Pharmacist = obtain medication (depending on their situation e.g. dependency and consumption of alcohol, age, pregnant, misuse of drugs etc)

-       Mental Health nurse/Psychiatrist = effects of alcohol on our mental health, provide information on addiction

-       Psychiatrist = diagnose, treatment & prevention of mental health, emotional & behavioural disorders

-       Psychiatrist = Aware them of the effects of alcohol on the body & brain

-       Social worker

-       Counsellor = offers emotional and psychological support to people

-       Health organisations & charities e.g. AA, MIND

-       Charities = alcohol concern, Drinkaware

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https://www.drinkaware.co.uk/

Drink Aware UK is a charity that helps reduce alcohol misuse.
There is an interactive app available to download on your phone which can calculate the amount of alcohol units a person has consumed.

There is an advice section that allows someone to ask for help about themselves or someone else

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Moderating Alcohol Consumption  - A Valuable online resource 

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Moderating Alcohol Consumption  - A Valuable online resource 

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https://www.nhs.uk/LiveWell/Alcohol/Pages/Alcoholhome.aspx

The NHS choices website offers help and guidance about alcohol and promoting a healthy lifestyle.
It has advice such as tips on cutting down, the risks of binge drinking

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https://www.alcoholics-anonymous.org.uk/

Alcoholics Anonymous UK - a free self-help group which involves regular support groups.
It allows people to meet others in similar situations and share experiences, strength and hope with each other.