How GPs can help patients reduce drinking in line with new guidelines

Doug Hendrie

9/12/2020 3:00:56 PM

Healthy Australians should drink no more than 10 standard drinks a week, according to new NHMRC guidelines.

Person taking bottle of beer from fridge.
Helping patients manage alcohol risks is general practice bread and butter.

That is a drop from the 14 standard drinks suggested in the previous version of the National Health and Medical Research Council (NHMRC) alcohol guidelines, which were released in 2009.
The decrease comes after many new studies pointed to the links between relatively low levels of drinking and increased risk of cancers, including bowel and breast.
The latest guidelines were released this week.
Chair of the NHMRC Alcohol Working Committee Professor Kate Conigrave said the clearer links between alcohol and cancer ‘has led many countries around the world to lower their recommendations on the maximum quantity of alcohol a person should consume’.
The recommendations on session drinking are unchanged at four standard drinks per day.
Upgraded recommendations for children and people under 18 years of age state that they should not drink alcohol at all to avoid harms to their health.
Similarly, women who are pregnant or planning to be should also abstain from alcohol to avoid harming their unborn child, while those who are breastfeeding are also recommended not to drink.
NHMRC CEO Professor Anne Kelso said the guidelines are not about telling Australians what to do.
‘We’re providing advice about the health risks so that we can all make informed decisions in our daily lives,’ she said.
Alcohol claims more than 4000 lives annually in Australia, causes around 70,000 hospital admissions and is linked to many cancers among more than 40 medical conditions.
The guidelines offer GPs an excellent opportunity to discuss drinking habits with patients, according to Dr Hester Wilson, Chair of the RACGP’s Specific Interests Addiction Medicine network.
She told newsGP the guidelines are a step forward and synthesised much new research.
‘It’s an opportunity to flag with patients that having no more than four drinks per night decreases acute harms, while 10 drinks a week decreases longer term harms,’ she said. ‘It’s a really great opportunity for us to do a blitz when we see our patients.’
Dr Wilson said that while younger people ‘absolutely’ understand what a standard drink is, older patients may not.
‘It’s important to engage where patients are at. It’s not our role to tell them how to live their lives, but to give them scientific information,’ Dr Wilson said. ‘One of the things that’s really helpful as a GP is that you can link their risk to something specific to them.
‘If they have high blood pressure or obesity or a family history of problems with alcohol, linking alcohol to that health concern makes it real for that person.’
Dr Wilson said new research shows concerning links between low levels of drinking during pregnancy (between one and seven drinks a week) and having children with higher rates of anxiety and behavioural issues.
‘Binge drinking in young people is another real risk,’ she said.
‘There is acute risk but there may also be ongoing risk. There may be some impairment as a result of even fairly moderate binge drinking.’
Dr Wilson suggests focusing conversations on younger people, pregnant women or those considering it, as well as people over 65, due to the increased risk of developing dementia. People who have drunk more heavily during COVID could also benefit from a conversation.
‘During the pandemic, there were those who had alcohol problems in the past and were managing it, and who found themselves relapsing with the stress of COVID,’ she said. ‘Others had drinking creeping up.
‘They started drinking earlier as a stress release, and drank more at home on their own as a way of managing anxiety and stress rather than having a good time.
‘Now that we’re hopefully coming to the end of the pandemic, with vaccines on the horizon, it’s a really good time to be thinking about drinking – especially with Christmas and New Year’s.
‘If we can have conversations that bring drinking down, that has a net benefit for the whole community. And if we can flag someone who is dependent on drinking and refer or treat them, that will have a real benefit for a significant alcohol issue.
‘We need to know where to send them if we can’t do it ourselves.’
A ‘standard drink’ is defined as one that contains 10 g of pure alcohol, which translates to around 285 ml of full-strength beer, a can of mid-strength beer, 100 ml of wine, or a single shot of spirits.
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