Alcoholic Liver Disease kills: why we need a new focus on educating about the dangers of drink

The Amanjit Jhund NHS Column

Last week I attended a Progress event at the House of Commons on “New thinking for Britain’s next decade”. Jack Straw spoke at the event and one of the topics he covered was the blight that alcohol abuse and its fallout has on our communities. After his speech I asked him his opinion on how he thought we should combat this. While he spoke about the need to review 24 hour drinking licences (which I agree with) he also voiced an opinion that we should look at more closely: the prospect of minimum costs for alcohol.

Minimum prices for alcohol based on units have become something a of a vogue in recent months. The SNP government tried to introduce such measures in Scotland and despite failing to do so they are set to try again in the new year. Meanwhile, medical associations such as the British Medical Association (BMA) and the health select committee have been lobbying hard for such measures.

The prospect sits uneasily with me, as I recognise that such measures will affect the poorest in our society disproportionately with potentially no real effect on the vast majority of alcoholics, who in possession of a true addiction will do whatever it takes to acquire the substance.

One of the reasons for the increase in the rates of Alcoholic Liver Disease (ALD) is the increase in middle class drinkers: those that will drink a bottle of wine a night while believing that because they are not stumbling about the streets pissed or falling over that they are not endangering their health. These drinkers will not be affected by the proposals over minimum pricing. They need to be targeted in a different way.

Rather than pursuing minimum costs, which will punish the poorest and responsible drinkers but not always those drinking to excess, I would rather see us focus on alcohol education policies first.

Alcohol abuse is something that I have dealt with for most of my adult life. I come from a family with a history of alcohol abuse, I have seen family members die from it and I currently have a cousin drinking himself into an early grave. In fact as a Sikh male I have a significantly higher risk of developing alcoholic liver disease compared to the general public. These factors combined with my being a Glaswegian rugby playing doctor mean that the only way I could increase my risk of being an alcoholic would be to open a pub.

I don’t drink much these days (in fact I tend to worry more about my hardcore diet Irn Bru addiction) but I think that my background and my own nascent alcohol abuse at university played a part in my choice of speciality as a doctor. I chose to pursue a career in Hepatology (livers) and as a result I’ve worked in some of the most prestigious liver units on both sides of the Atlantic. I’ve spent most of my twenties sticking needles the size of a forearm into the abdomens of alcoholics and attempting to persuade them to stop drinking.

Some of them do stop, but not many. It is far more cost effective to educate people against drinking to excess in the first place.

In the past decade we have seen a consistent increase in the rates of death from alcoholic liver disease. It is estimated that over the next ten years we will see approximately 100,000 people die from direct consequences of alcohol abuse, and many more will be scarred from the social and economic fallout.

Contrast this with smoking, of which we have seen a consistent decline amongst both males and females since the 1970s. In this sphere it has been the tobacco education campaigns that have become the number one reason why individuals try to quit, and why young people are less likely to start smoking than ever before.

Ask any adult and I’m sure that they can list the most serious outcome of tobacco use, namely lung cancer. They understand exactly what it is and also that it is likely to kill you. They also have a very clear idea of what an individual with lung cancer would look like and the problems they might have. In many ways it’s an easy message to convey: smoke and you get cancer.

Compare this to alcohol abuse. Ask anybody what happens if you drink too much and I’m sure that they can come up with the answer that it causes liver disease. Then try asking them what ALD means and you’re likely to get a much more vague answer (I tried this out on a secondary school teacher and all he could tell me about alcohol abuse was that you get liver disease and then might die). In fact, even when you mention alcohol abuse most people get a mental image of binge drinking nights out on the town rather than the serious consequences of abuse. For many people these mental images convey a pleasurable night out whilst for others possibly abusing alcohol at home by having a bottle of wine they have no relevance whatsoever.

Alcohol abuse can contribute to many forms of cancer but alcoholic cirrhosis and its complications remains the main cause of death for alcoholics. Most people, however, have no idea of exactly what an individual with alcoholic cirrhosis looks like or what the complications are. Recently Louise Rhymes released pictures of her daughter Stacey who died at the age of 24 from ALD. The pictures showed how the years of abuse had affected her daughter’s youth, beauty and health. I admire Ms Rhymes’ stance and personal bravery because I believe that it is only by exposing people to the realities of alcohol abuse and the results that we can hope to combat this problem.

I would like to see a more aggressive, graphic representation of end stage liver disease both in the media and in health promotion campaigns. The aim of this would not be to scare people, but to educate them. I’m not suggesting that we should print pictures of cirrhotic individuals on beer bottles but we do need to increase the exposure of the public to the very real outcomes of alcohol abuse. When people hear the phrase “alcohol abuse” I would rather that instead of thinking about men and women falling about in town centers on a night out people might have a mental image of the true consequences of abuse instead. I would rather have them think of Miss Rhymes and others like her.

We could start by using cirrhotic patients in alcohol awareness adverts showing the true face of alcohol abuse. I would also like to see cirrhotic patients utilised in the health promotion videos and leaflets used to teach our senior secondary school children about alcohol abuse. We need to show these people vomiting up blood, with distended abdomens, being pierced by a succession of needles just to try and keep them alive.

It’s only by educating children about responsible alcohol use and the consequences of its abuse that we will have a chance to reverse the rather dangerous trend of younger people drinking ever increasing amounts at an age when the damage to their bodies is multiplied. This is a time-bomb that will go off when these children reach their twenties when, just like Miss Rhymes, it may already be far too late to reverse the damage.

Someone once said that we should focus on “education, education, education” and I’m inclined to agree. It may not be as easy, sexy or headline grabbing as alcohol licenses or minimum prices but I do think that it has a better chance of success. Then again tough on alcohol, tough on the…er..causes of alcohol does a have a certain ring to it.

I think it needs some more thought so I’m off to the pub for a cheeky pint.