Speeches

Speech by Minister for Health and Children, Mr Micheál Martin T.D. at the opening of the Conference on “The Burden of Alcohol Misuse in the General Hospital”

Introduction

Good morning Ladies and Gentlemen. It is a pleasure to be here with you at the opening of this conference on the burden of alcohol misuse in the general hospital. The issue being discussed here today, that of alcohol misuse, is one on which I have spoken frequently in recent months.

It is an issue which impacts on every aspect of Irish life, on the individual, on society, on our health system. It is an issue which must be explored and examined at every opportunity and in every setting if we are to make progress towards its resolution. This conference will, I hope, introduce some important new ideas and will play a part in improving the detection and treatment of alcohol misuse.

Consumption

There can be no doubt now that the level of alcohol consumption in Ireland has reached a chronic level. We consistently rate among the top one or two in European surveys.

This is a worrying trend but what is of even more concern is the rate of increase in our consumption. Between 1989 and 1999 per capita alcohol consumption in Ireland increased by a massive 41%. This statistic is even more startling when compared to that of other EU countries.

Nine of the European Union member states showed a decrease in alcohol consumption during the same period and three countries showed a modest increase of just over 5%. The implications of this trend are hugely significant. If we look back ten years from now and observe that this curve has not peaked then the consequences for our society and indeed our health system are frightening.

The levels of consumption are important but so too are the patterns of drinking. Drinking patterns were examined as part of the first national lifestyle survey in 1999. The survey reported on the drinking habits of those aged 18 years and over. Important age differences emerged which showed that the younger age groups 18-24 and 25-34 drank less often than older age groups but were more likely to engage in high risk drinking when they did drink. The statistics on underage drinking are equally troubling. The ESPAD survey, which was published last year showed that one-third of Irish 15-16 year-olds reported binge drinking three or more times in the last 30 days. This is the consumption but what are the consequences?

Alcohol related harm

Inappropriate drinking results in immense suffering and costs which impact on the health and welfare of the whole community, both on the individual drinker themselves and for those around them. While the economic costs of alcohol consumption are difficult to calculate, the figure was estimated in 1999 to be in the region of €2.4 billion annually. This amounts to 1.7% of Gross Domestic Product. This figure includes costs such as healthcare, road accidents, alcohol related crime and lost productivity. The scale of the problem is horrifying.

Some of the individual statistics make for disturbing reading. If we look at road accidents for instance – overall, there has been a marked decrease in both the number of people killed and injured in road accidents since 1997. However, the number of people killed during the time most associated with drink-driving, 9pm to 4am, has not substantially decreased. In fact this period of time accounts for one-third of all road deaths.

The prevalence of interpersonal violence also testifies to the harm associated with binge drinking. In Ireland, there has been an increase since 1995 in assaults and public order offences, the vast majority of these being alcohol related.

These and other indicators of harm are important but perhaps the most important for me as Minister for Health and Children and for many of the health professionals here today are the indicators of physical and mental health and I am sorry to say that the figures are equally grim.

The finding that one in five hospital in-patients were seriously mis-using alcohol demonstrates the extent of the problem in Ireland. Equally, the statistic that one in four patients attending Accident and Emergency Units are there as a result of alcohol misuse is an intolerable one.

Alcohol and health

Alcohol disorders continue to be a main cause of admissions to psychiatric hospitals, especially for men. In 1999, alcoholic disorders accounted for 20% of male admissions and 11% of female admissions to psychiatric hospitals. Alcohol is frequently listed as a contributory factor in deaths from suicide.

Many incidents of drowning, falls and burns are linked to alcohol. In Ireland in 1997, 23,500 people were admitted to acute hospitals as a result of accidental falls and a study carried out in Australia found that 34% of falls such as these can be attributed to alcohol. When we see that the average stay in hospital of these people was 5.76 days it becomes clear that alcohol related falls alone are contributing significantly to bed occupancy in our hospitals with all of the associated costs and difficulties this causes.

These one-off problems are often caused by individuals who drink too much on one occasion. However, people who drink heavily on a regular basis can also suffer from acute alcohol-related harm.

Illnesses such as cirrhosis of the liver, cancers of the mouth, pharynx, larynx, oesophagus and liver have all been linked to long term alcohol use. We have seen increases in many of these in recent years.

While it would be comforting to think that patients who misuse alcohol are being detected by their attending physicians, the truth, as shown by Dr. Sheehan´s recently published research, is that all too often people with alcohol-related disabilities are not being detected.

Dr. Sheehan´s Research

Dr. Sheehan´s research is important for a number of reasons. There is conclusive evidence to show that early interventions, both in the hospital setting and at General Practice level can be extremely effective in treating alcohol problems.

In order to initiate these interventions however, they must be detected and research such as Dr. Sheehan´s which highlights the success or inadequacy of detection systems provides valuable information which I am sure will help to direct future policy in this area.

A pilot study, Alcohol Aware Practice is currently underway to improve the detection rate and treatment of alcohol problems in General Practice. This is an initiative of the Irish College of General Practitioners for which I was happy to provide financial support.

It is an educational resource programme to raise awareness and teach clinical skills and includes screening and assessment techniques, treatment methods, brief intervention and prevention. The information gathered from studies such as these will, I am sure, increase detection and treatment rates for those who are at risk from alcohol misuse.

The information pack “Alcohol and the Body” which has been developed by the Mater Hospital, in association with MERCK Pharmaceuticals will clearly prove to be a very useful tool in raising patients´ awareness of the damage caused by sustained heavy drinking.

Where to from here?

The results of this research will, I am sure, go on to influence future clinical policies but that can only be one strand in a tapestry of approaches to tackle the issue of alcohol misuse in Ireland.

Improvements in detection and treatment are critical but it goes without saying that preventing the problem before it arises are always preferable.

With this goal in mind, the Health Promotion Unit of my Department is involved in a number of initiatives to tackle inappropriate drinking. Work is ongoing in schools, in the youth sector and in colleges. A Responsible Serving of Alcohol training programme is underway and issues such as the advertising of alcohol are being examined. A three-year campaign aimed at raising public awareness is underway.

I recently announced the setting up of a Task Force on Alcohol. The purpose of the Task Force is to provide advice to Government and public bodies on measures to prevent and reduce alcohol harm. I look forward very much to receiving its recommendations.

Conclusion

Once again, ladies and gentlemen I would like to thank you for inviting me to speak at the conference here this morning. The issue being debated is a critical one and I wish you every success in your discussion. I would like to thank Dr. John Sheehan and his colleagues for carrying out this research and Merck Pharmaceuticals for their support of the project.

I understand that Mr Eamonn Brasil, Consultant in the Accident and Emergency Department, in association with Dr. Sheehan, and my own Department is carrying out further research work on the topic of alcohol misuse in Accident and Emergency patients. I would like to wish them every success with this venture. I trust that you will find the remainder of this conference both informative and useful.

Thank you.