Professor Thomas Phillips, Institute for Clinical and Applied Health Research, University of Hull, Professor Simon Coulton, Centre for Health Services Studies, University of Kent, and Professor Colin Drummond, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, identify a need for a holistic approach to healthcare for patients with chronic alcohol disorders.
Chronic alcohol disorders such as alcohol dependence and alcohol liver disease are disabling conditions that develop over years. Alcohol dependence is commonly characterised by a loss of control over alcohol and a continued pattern of drinking despite harmful effects and problems. Those diagnosed with alcohol liver disease will commonly report excessive drinking patterns in the years leading up to being first diagnosed, and many will also report a history of alcohol dependence.
The results of regular excessive drinking have now been linked to over 200 diseases and medical conditions such as cancer, cardiovascular disease, mental health problems, as well as complex social problems. The dose-dependent relationship between the alcohol consumption and consequences means those with chronic alcohol disorders experience greater levels of harms. Common with other chronic conditions those from a lower socioeconomic status are disproportionally affected resulting in wide variations in need across communities.
In England it is estimated that 600,000 adults with alcohol dependence require treatment by specialist alcohol services yet only 15% of this group gain access to these services each year. Although, the estimated number of people in need of help has remained similar over the last decade alcohol-related hospital admissions continue to rise. National available data reveals an annual increase in alcohol-related hospital admissions since 2003/04 which now exceed 1.1million per annum.
The continued urge, desire and need to continue to consume alcohol despite harms and predictable negative consequences is frequently misunderstood as a choice by many non-specialists. In fact, the majority of those with alcohol dependence want to reduce their alcohol consumption and regularly make quit attempts. However, the complex interaction between chronic alcohol disorders and related problems often results in individuals prioritising immediate problems such as mental health crises, housing issues and unemployment above help-seeking for their drinking. For many however the development of secondary medical problems results in unplanned help-seeking via emergency departments.
Concerns over this rise in hospital admissions has resulted in the UK Government committing to the expansion of Alcohol Care Teams within District General Hospitals over the next five years. The NHS Long Term Plan published in January 2019 aims to develop Alcohol Care Teams in those hospitals with the highest rate of alcohol-dependence admissions. These services aim to provide a 7-day service that improves the quality of care during admission and increase access and engagement of individuals into specialist community treatment. The ability of the Alcohol Care Teams to reduce emergency department attendances, lengths of stay in hospital and readmissions will rely on meeting the needs of individual patients.
The use of routine collected hospital data to compare different groups with alcohol disorders has helped to identify the needs of those with chronic alcohol disorders, who are frequently admitted to hospital via emergency departments in England.
Our study of 1.2 million individuals, published in Alcohol and Alcoholism, compared those without an alcohol disorder, or those with an acute alcohol disorder (i.e. intoxication), against those with chronic alcohol disorders.
The results reveal that individuals with chronic alcohol disorders experience greater emergency department attendances, hospital admissions and total bed days. Analysis of potential costs indicated that when similar cases are matched those with chronic alcohol disorders exert an excessive financial burden estimated to be a 47% cost increase.
Linking the data from hospital admissions to emergency department attendances identified those who experience alcohol dependence, alcohol liver disease, or other chronic alcohol disorders commonly present with mental health problems, other chronic medical conditions, and social problems.
Our findings suggest the new Alcohol Care Teams will require the development of service models and care pathways with community services that comprehensively address the holistic needs of those patients with chronic alcohol disorders.