What is the most common drug of dependence GPs face?

If you read the paper or watch the TV news, you would assume Australia’s risky drug-taking culture revolves around party drugs and methamphetamines.
 
But the reality, according to Melbourne GP and addiction medicine specialist Dr Paul Grinzi, is more prosaic – and challenging. For at least half of all his patients with issues of a dependency, alcohol is the major issue.
 
‘You’ll see the stories of ice addicts in the media. They’re drugs which are important, but are much less common primary care,’ he told newsGP. ‘The common [drugs] aren’t sensational enough to get media attention.
 
‘Alcohol is an accepted part of Australian culture, so harms are often under the radar. But, as a GP, you can see them front and centre – if you recognise the signs. Hypertension, reflux disease, osteoporosis, cognitive impairment, heart disease.
 
‘There’s a whole bunch of issues where alcohol can contribute.’
 
Dr Grinzi said it is significant that addiction medicine is now known as ‘alcohol and other drugs’ rather than ‘drugs and alcohol’.
 
‘It puts it in perspective – alcohol is number one,’ he said.
 
Dr Grinzi said the legal drug’s sheer ubiquity means it can sometimes be easy to miss as a factor.
 
‘It’s normalised in our culture so we can discount the importance of alcohol as a trigger,’ he said. ‘You might have someone in … who didn’t know his seven beers the previous night might have triggered today’s gout.
 
‘Recurrent falls, dementia, sexual health, there are opportunities for us as GPs to link a presenting complaint to an alcohol assessment.’
 
Dr Hester Wilson, Chair of the RACGP Specific Interests Addiction Medicine network, told newsGP nicotine is another dependency that is often overlooked.
 
‘I would say the addiction we most commonly see is nicotine. We don’t see it as a drug, like we do alcohol, but it is a dependency,’ she said.
 
Dr Wilson said she finds that patients with alcohol dependency fall roughly into three groups.
 
‘You’ll have people who are a bit dependent but who realise their alcohol use isn’t working for them and they decide to change,’ she said.
 
‘At the other end, you have people who are really unwell, and who, if they don’t change their behaviour, will end up dying from alcohol. They need specialist support as well as from their GP.
 
‘But in the middle, you have the group who are dependent but still kind of functional. They’re really tricky because they’re functional, but at risk of harms.’
 
Dr Wilson said that despite all of the media – and political – attention on ice and amphetamine use, people with these dependencies are a very small minority, at around 2% of the population.
 
‘Ice is much easier to stigmatise – you hear talk about this demon drug, because it’s illicit,’ she said. ‘It’s very easy to stigmatise all illicit drugs, as opposed to alcohol and nicotine.’

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