Guidelines for preventive activities in general practice

Mental health and substance use

Alcohol

Guidelines for preventive activities in general practice
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Mental health and substance use | Alcohol

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Alcohol is the most commonly used drug in Australia. Behind tobacco, alcohol is the second greatest cause of drug-related harm. Approximately 8 out of 10 adults drink alcohol.1 In a 2019 survey, 76.6% of the Australian population aged ≥14 years reported having consumed alcohol in the previous 12 months.1

Alcohol use has risks at any level, and can cause harm to the person who drinks, as well as the people around them, particularly household members.3 Alcohol consumption has been associated with a range of long-term conditions, such as cardiovascular disease; some cancers, including breast, colon, oropharynx and liver cancer; type 2 diabetes; nutrition-related conditions; obesity; liver disease; mental health conditions; alcohol use disorders; and cognitive impairment.3 It has also been associated with risks to the fetus during pregnancy (eg fetal alcohol spectrum disorder [FASD]) and to the baby through breastfeeding.3 In 2015, drinking alcohol contributed 14% of the burden due to homicide and violence, and alcohol can contribute to family disruption, crime, road accidents, work-related harms and community safety issues.3

Men tend towards higher levels of risk-taking behaviour, and thus have a greater overall risk of immediate harm from drinking (eg road crashes, falls and self-harm),3 and the disease burden for men is greater;4 however, women are more susceptible than men to the direct physiological effects of alcohol. For women, the immediate effects of alcohol occur more quickly than for men; they also last longer. In addition, lifetime risk of disease will climb at a faster rate for women once low levels of alcohol use have been exceeded.3

Screening

Recommended as of: 28/06/2024
Recommendation Grade How often References
Screen adults aged ≥18 years, including pregnant women, for unhealthy alcohol use. The Alcohol Use Disorder Identification Test – Consumption (AUDIT-C) tool can be used to assess this.
Provide persons engaged in risky or hazardous drinking with brief behavioural counselling interventions to reduce unhealthy alcohol use.		 Conditionally recommended Every 2 years (Practice point) 4

Preventive activities and advice

Recommended as of: 28/06/2024
Recommendation Grade How often References
Advise healthy men and women drink no more than 10 standard drinks* a week and no more than four standard drinks* on any one day to reduce the risk of harm from alcohol-related disease and injury.

*The Australian definition of a standard drink is 10 g alcohol. Be aware of international variation.		 Recommended (Strong) Opportunistically
 		 3
 
Advise children and people aged <18 years not to drink alcohol to reduce the risk of injury and other harms to health. Recommended (Strong) N/A 3
Advise women who are pregnant or planning a pregnancy not to drink alcohol to prevent harm from alcohol to their unborn child. Refer to the Preconception and During pregnancy chapters Recommended (Strong) Opportunistically
 		 3
 
Advise women who are breastfeeding that not drinking alcohol is safest for their baby. Recommended (Strong) Opportunistically
 		 3
 
Those with at risk patterns of alcohol consumption should be offered brief advice on the risk of drinking.
Risky patterns of drinking are more common in:
  • young adults aged 18–25 years
  • people aged >60 years
  • people with mental or physical health conditions
  • people with a family history of alcohol dependence
  • people who use illicit drugs or take medications that interact with alcohol.
Be alert to drinking in young people aged <18 years.
 		 Practice point N/A 3

Alcohol-related harm

The risk of alcohol-related harm rises with increasing alcohol consumption.3 There is no threshold of alcohol consumption below which there is no risk. The National Health and Medical Research Council (NHMRC) Australian guidelines to reduce health risks from drinking alcohol provide guidance such that if they are followed by a healthy adult, the risk of dying from an alcohol-related condition or injury is less than 1 in 100. Some people are recommended to abstain from alcohol to lower their risk of alcohol-related harm.

Role of the GP

Patients are positive towards the role of GPs in health promotion, and this is enhanced when:6

  • there is perceived relevance of the alcohol enquiry dialogue to the consultation
  • appropriate approach and language are used in the patient–doctor interaction
  • unease regarding the moral and stigmatising dimension of alcohol consumption is alleviated.

Reasons for presenting can also influence the perceived acceptability of alcohol questions by patients.7

Brief interventions

Alcohol brief interventions undertaken by GPs are effective in reducing risky drinking.8

Assess whether there are possible harmful interactions between medications and alcohol for people with a mental health problem made worse by alcohol (eg anxiety and depression) or for people taking multiple medications.

For specific recommendations and advice for Aboriginal and Torres Strait Islander people, please refer to the Alcohol section in the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people.

Individuals with health conditions that can be caused or worsened by alcohol consumption are at risk of exacerbating their condition if they continue to drink.3 These conditions include alcohol dependence, various liver diseases (eg alcoholic hepatitis, cirrhosis, non-alcoholic fatty liver disease and viral hepatitis), pancreatitis and epilepsy.3

Commonly prescribed categories of medications including, but not limited to, benzodiazepines, opioids, analgesics, antidepressants, anticoagulants, anticonvulsants, antibiotics, antihistamines, anti-inflammatories, antipsychotics and drugs used for the management of conditions such as erectile dysfunction or diabetes are known to interact with alcohol, potentially leading to severe side effects when used together.3

  1. Australian Institute of Health and Welfare. National drug strategy household survey 2019. Australian Government, 2020 [Accessed 21 February 2024].
  2. The Royal Australian College of General Practitioners (RACGP). Applying the 5As to each risk factor. In: Smoking, nutrition, alcohol, physical activity (SNAP). RACGP, 2015 [Accessed 18 October 2023].
  3. National Health and Medical Research Council (NHMRC). Australian guidelines to reduce health risks from drinking alcohol. NHMRC, 2020 [Accessed 21 February 2024].
  4. Australian Institute of Health and Welfare (AIHW). Alcohol, tobacco & other drugs in Australia. AIHW, 2023 [Accessed 21 February 2024].
  5. U.S. Preventive Services Task Force (USPSTF). Unhealthy alcohol use in adolescents and adults: Screening and behavioral counseling interventions. USPSTF, 2018 [Accessed 21 February 2024].
  6. Leong L, Hespe C, Zwar N, Tam CWM. Alcohol enquiry by GPs – understanding patients’ perspectives: A qualitative study. Aust Fam Physician 2015;44(11):833–38.
  7. Leong L, Zwar N, Hespe C, Tam CWM. Consultation contexts and the acceptability of alcohol enquiry from general practitioners – a survey experiment. Aust Fam Physician 2015;44(7):490–96.
  8. Beyer FR, Campbell F, Bertholet N, et al. The Cochrane 2018 review on brief interventions in primary care for hazardous and harmful alcohol consumption: A distillation for clinicians and policy makers. Alcohol Alcohol 2019;54(4):417–27. doi: 10.1093/alcalc/agz035.
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