The consequences of risky and harmful alcohol consumption are known by health professionals working in the field of primary care. However, despite the fact that many of them say that screening of this type of consumption is carried out systematically, the percentages of the population screened are low and, in general, patients do not recall being asked about it. Since many risk drinkers are unknown to their doctors, a systematic approach would be recommended to facilitate their identification.

Currently, within the preventive activities carried out in primary care, the detection of alcohol consumption is carried out through its quantification and various tests (CAGE, MALT, AUDIT, FAST…). The lack of systematization on this topic makes many professionals see this activity as “complicated”, “uncomfortable” and “low priority”. In addition, there are patterns of consumption, such as intensive or occasional binge drinking (drinking≥6 drinks in a single session of consumption), which go unnoticed if consumption is assessed only by quantification. This type of consumption pattern is common in young people between the ages of 15 and 34 and is closely related to mortality from traffic accidents, suicide or violent assaults.

How to approach risky alcohol consumption from primary care

Both the EU Strategy to help the member states reduce alcohol-related harm and the Action Plan to reduce the harmful use of alcohol in the European WHO region 2012/2020, mark the lines that member states must follow to reduce the harm related to risky and harmful alcohol consumption. Among them, prevention through early identification and brief intervention are essential to achieve the objectives proposed in these policies, with health systems – and especially primary care – being an essential pillar in their development.

Any preventive intervention on alcohol from the health field goes through the early identification of risky consumption since these often go unnoticed. It should be borne in mind that most of the damage caused by alcohol appears among people who are not dependent, if only because there are many more of the latter. Furthermore, no one develops a dependency without having previously maintained a risky consumption.

Brief intervention from primary care avoids illnesses and premature deaths, being the most cost-effective health intervention, only behind the intervention on tobacco consumption. Primary health care is in a privileged position to prevent and minimize the harm caused by alcohol.

The consequences of risky alcohol consumption

In Europe, where the number of sober living homes has increased considerably over the last few years, the risky and harmful consumption of alcohol is one of the first preventable causes of morbidity and mortality, therefore, it is necessary to think about all the consequences of alcohol consumption and not only those derived from possible dependence. Chronic causes account for 60% and acute causes 40% of this alcohol-related mortality.

In Spain, it is estimated that there are 2 million people who consume alcohol at risk, that is, 7.4% of the population – of which 0.3% are possible dependents. In recent years, there has been an upward trend in binge drinking and episodes of heavy alcohol consumption.

Among the chronic causes, digestive diseases are the cause of 40% of all mortality, with cirrhosis being the cause that contributes to the highest number of deaths.

Among the acute causes, traffic accidents represent 30% of the mortality attributable to alcohol. It is also implicated in 23% of suicide cases, being the third leading cause of death among young people aged 15 to 24.

Alcohol harms not only those who consume it but also those around them. The concept of “passive or involuntary drinker”, making a simile with tobacco consumption, refers to the harm that people can suffer due to the consumption of alcohol by others.

The relationship between consumption and mortality is complex and variable depending on which disease is discussed. Taken together, the risks clearly outweigh the potential benefits. Therefore, although low doses of alcohol have been associated with a protective effect on cardiovascular disease, the overall effect of alcohol is detrimental. The Global Fund for Cancer Research has indicated that there are no safe levels of alcohol consumption in relation to cancer risk. Its consumption should never be recommended to prevent cardiovascular disease or any other cause of mortality.

Conclusions

The risky and harmful consumption of alcohol is an important public health problem in Europe due to the burden of disease and suffering that it produces and the associated costs that it entails.

Various international organizations recognize preventive action (screening and brief intervention) from the health systems as a priority, mainly from primary care.

In primary care, there is a need to systematize and unify criteria when addressing risky alcohol consumption and to reinforce the training of health personnel in this area.

For all these reasons, in Spain, the Ministry of Health, Social Services and Equality (General Directorate of Public Health, Quality, and Innovation) has decided to develop a training tool, accredited by the Continuing Training Commission of the National Health System, with the motto «Get wet with alcohol», has been prepared together with the Spanish Society of Family and Community Medicine (semFYC).

Through a Virtual Classroom, the program consists of PPT presentations, texts, bibliography, FAQ, videos and various teaching support materials, to promote clinical sessions and workshops in health centers, teaching units, federated societies and health services.