The pharmacy profession is very good at talking to people about their medicines and, as experts in medicines, we keep up to speed with the latest guidance and evidence. Despite working through challenging climates, we aspire to be as holistic and patient-centred as possible.
Alcohol dependency is a drain on healthcare resources and has wider socioeconomic consequences. Millions of people across the UK have personal experience of this issue. It is estimated that four out of five dependent drinkers are not in treatment. People affected are stigmatised, can be vulnerable, have often experienced trauma and frequently present with other physical and mental health needs. But when a patient uses alcohol, what do we do?
Specialist drug and alcohol services are typically commissioned to deliver an integrated service, which gives people access to psychosocial (and prescribed) interventions, regardless of the substance that they have a problem with. Sadly, our public health budgets continue to shrink at a time when alcohol-related deaths and hospital admissions are increasing, so services and their commissioners often cannot afford to do everything they would like to. Wouldn’t it be great to see more community alcohol detox by pharmacies? Pharmacy is already involved in pathways mapped for some areas — for example, on the remote Isles of Scilly and in rural Cornwall — so it could happen more widely across the UK too.
There’s also good evidence to support the use of brief interventions, which don’t take hours to do or require highly specialist training. Some community pharmacy contractors are commissioned to do this — some routinely ask questions about alcohol use in their daily practice without even realising. Asking open, non-judgemental questions during a medicines use review, for example, can be highly effective. With 1 in 8 people reducing their drinking as a result, it has been shown to make a difference.
But how well trained are pharmacy professionals in spotting potential signs of alcohol withdrawal? And where does funding for training come from? There are not nearly enough pharmacists working in substance misuse, but pharmacy is an enormous asset to organisations it does work in. And this isn’t just a ‘pharmacist’ thing — we must not forget about the important role that pharmacy technicians play too.
Check whether there is a specialist liaison team in the local hospital, or someone from the community service who can help you organise a plan for supporting post-discharge patients. Be aware that a care pathway may not exist in your area yet. In primary care, if there isn’t a local specialist pharmacy resource, there may be someone else who might be able to help; if you’re unsure, investigate how you can contact your local substance misuse service and whether there are pathways in place for signposting and referring people in to treatment.
Checking adherence is essential — not just to medication, but also with alcohol. Suddenly stopping alchol intake when drinking dependently can be fatal, and repeated detox increases the risk of complications. And when a patient is drinking dependently, their adherence to medication may not be good, meaning that dosing frequency needs to be thought about more carefully. Interactions must be considered too: we’re familiar with enhanced sedation when alcohol is used alongside medication that can also cause drowsiness, such as opioids and benzodiazepines; being alert to the risk of accidental overdose becomes even more important.
We also have a role in challenging stigma. Remember, no one wakes up thinking “I’m going to become dependent on alcohol today”. Supporting loved ones who have a problem with alcohol can be exhausting and isolating, but we need to look, listen and ask, and not be afraid of the responses.
We need to look after ourselves and each other too. We work in high-pressure environments, with challenging targets and scarce resources. Signs that too much alcohol is being drunk can include routinely reaching for a drink to relax, underestimating how much is being drunk or drinking more to get the same effect as before. Support is out there for those who need it. In the past three years, Pharmacist Support had provided 156 acts of support (including help with concerns about alcohol) through their Addiction Support Programme. Group and one-to-one sessions are available, and can also be offered by other organisations and locally commissioned specialist providers, such as Addaction.
Reaching out for help and support when we need it isn’t just important, it’s vital. An empty tank will take you nowhere; take time to refuel.
Roz Gittins, director of pharmacy, Addaction