SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
Dry January and different strokes for different folks (A tale of two drinkers) (Feb 2014)

As the role alcohol plays in ill health and social dysfunction is increasingly in the spotlight, the whole SMMGP team decided to support Alcohol Concern by taking part in Dry January. It would be fair to say that it was anticipated that it would be harder some of us (i.e. me) than some of the others.

I decided that the best approach for me would be to tell as many people as possible that I was taking part, thus feeling compelled to complete it. One of the knock-on effects was that one of my GP partners and his wife decided to join in, I also had several interesting conversations with patients including one with an older lady who said "Oh, I didn't realise you were an alcoholic and needed to dry out". Hopefully she now understands a little more about the concept of dependence!

Frank had an appointment about his high blood pressure, he was taking medication for this and we were discussing adding in another tablet. He is a self-employed plumber and has always admitted to drinking "a lot" at weekends and "a few" during the week. That said when work was busy he would sometimes go 3 or even 4 days without a drink. Now in his mid 40's he had watched his weight go up with his blood pressure, especially after he stopped smoking 3 years ago. He was surprised when I suggested he consider Dry January but faced with the prospect of more medication he somewhat begrudgingly agreed it might be worth a go.

Linda on the other hand brought her plan to participate in Dry January up with me. She told me a friend at work was intending to sign up to the campaign and she thought she would too. She had a stressful job with a firm of solicitors, had lost her driving licence due to drink driving 12 months ago and had been seeing the local CBT counselling service for anxiety and depression over the past few months.

This led to a deeper exploration of her drinking habits: she arrived home from work and immediately had a large glass of wine, followed by a couple more during the working week and probably twice this at the weekend.

She had gone a couple of days without a drink earlier in the year when she had flu but said she felt really ill and had been retching and shaky which she blamed on the virus.

An AUDIT score of 28 supported my view that she probably had a degree of physical dependence and after some persuasion she agreed to see our alcohol counsellor rather than attempt Dry January. She has done well and over the course of January she has cut back to about half a bottle of wine a day and towards the end of the month has even managed a couple of dry days, she is now focussed on getting her licence back and is starting to think that her life might be better without alcohol.

As for Frank he came in looking great, he had lost 4kgs in weight and his BP was back under control, I had thought he might struggle but he told me he had stopped going to the pub and started going for a run: "I'd like to do a marathon Doc, it's quite addictive this running, you know".

- Dr Steve Brinksman
Birmingham GP, SMMGP Clinical Director, RCGP Regional Lead in Substance Misuse for the West Midlands