ABC of Alcohol (4th edn)

Abstract

This classic is a tribute to the long-standing dedication of physician Alex Paton. He introduces co-editor, Professor Robin Touquet, who has pioneered the treatment of alcohol misuse in Accident & Emergency at St Mary's Hospital in London. Expert contributors ensure a true multidisciplinary approach. Although essentially a primer to alcohol, the book's length has virtually doubled to 57 pages. Interestingly, while the previous front cover shows a young male drinking, this fourth edition silhouettes what could be either a young man or a woman. Their wine glass clearly exceeds one unit, reflecting concern about binge drinking in young adults. Concepts are clearly defined and will inform health professionals, lay people and government, hopefully enhancing confidence in tackling alcohol misuse. Eric Appleby of Alcohol Concern highlights changing patterns of consumption, the powerful advertising lobby and binge drinking, particularly in young women and northern regions. The protective effects of alcohol in coronary heart and cerebrovascular disease are soon overtaken by all-cause mortality, when people exceed sensible recommendations. Successive governments have been ambivalent since alcohol generates taxes and employment. Hence, the National Alcohol Harm Reduction Strategy was delayed until 2004. Little wonder, since ten different government departments have an interest in alcohol policy with many in direct conflict. Paton describes absorption, metabolism, distribution and tolerance to alcohol and explains why women are more susceptible than men. Apparently, on average, six people are affected by each problem drinker. Genetic, familial, constitutional and environmental factors influence drinking patterns. Alcohol misuse is also often missed in older people. The Paddington Alcohol Test is a 1-min questionnaire for recognising alcohol misuse in A&E. Touquet describes the ‘teachable moment’, that window when the patient may be amenable to a brief intervention. He references the excellent Royal College of Physicians' report Alcohol, can the NHS afford it? – Recommendations for a coherent alcohol strategy for hospitals. Touquet highlights the recognition of Wernicke's encephalopathy and its prompt treatment with intravenous Pabrinex. Paton tables the litany of medical conditions associated with heavy drinking, and surgical problems, especially trauma, are highlighted. People who drink more than eight units per day have a 3-fold higher risk of postoperative morbidity, considerably reduced by pre-operative abstinence. John Henry gives a practical guide to interactions between alcohol and drugs, both legal and illicit, while Geoffrey Smerdon describes alcohol misuse in primary care. A GP can appreciate the perspective of the whole family. Currently, 98% of excessive drinkers who visit GPs' surgeries are not identified; sadly, the specification for essential services under the new General Medical Services Contract omits alcohol. Bruce Ritson succinctly reviews advice and counselling, treatment and resources. Two-thirds of excessive drinkers respond well to treatment, the long-term prognosis being surprisingly good with relapses forming part of recovery. Brief intervention should be offered when hazardous or harmful drinking is first identified. This comprises ten minutes' discussion and explanation, provision of a self-help booklet, and offering a further appointment in one or two weeks. He describes shared care, particularly with alcohol specialist nurses in hospital or the community, awareness of specialist services and the tremendous contribution of Alcoholics Anonymous, Al-Anon and Alateen. The illustrations and graphs, bullet points, boxes and index are excellent. I strongly recommend this book, both professionally and personally, especially to all alcohol healthcare professionals, hospital doctors, particularly A&E staff, students, lay people interested in alcohol, including politicians and Department of Health strategists. ABC of Alcohol, fourth edition, brings the subject right up to date. In 1994, I bought three copies of the third edition to loan to junior doctors and students writing articles or projects. Only one copy survives. I will not be lending my fourth edition to anybody!