Advice on-line

With all the razzamataz that seems to be essential these days, the government has launched NHS Direct on-line, its new health advice website, and has expanded the NHS Direct phone service to cover 65 per cent of the country. NHS Direct includes advice on alcohol consumption and problems.

The new on-line service will allow the public to deal with the most common health problems themselves, with the back-up support of a nurse who can be telephoned directly. Some doctors have expressed concerns at the growth of "cyberchondria".

Welcome from BMA

The NHS Direct healthcare guide has been composed after advice from doctors and nurse representatives and has been welcomed by doctors' leaders. John Chisolm, Chairman of the BMA's General Practitioners Committee (GPC) said:

• "I welcome the NHS Direct guide. Members of the GPC have been closely involved throughout its production. The guide will inform patients, empower them with the confidence to be more self-reliant and contribute significantly to ensuring the best use of GP's valuable time. Both the book and the on-line service should help patients use our NHS more efficiently and appropriately."

A significant proportion of GPs' time is spent dealing with alcohol-related problems and NHS Direct on-line has a large section on alcohol. This contains answers to many of the questions which are most frequently asked by the public. The present government's circumspect attitude to alcohol policy has been commented on extensively (Alert, No.3, 1999) and the website begins in the same vein. "Alcohol can be a source of pleasure and enjoyment, and is a positive part of life for many people. We all know that a drink can sometimes help us to unwind or to relax with friends." The use of the word "all" is either lazy writing or an insight into the attitude of the officials in the Department of Health who produced the text.

Daily benchmarks

The site discusses the levels of "sensible drinking" and daily benchmarks. The point is stressed that these daily benchmarks "apply to any day when you drink whether that's every day, once or twice a week, or only occasionally. Most people drink different amounts on different occasions. But not drinking on some days doesn't mean that you can drink more than the benchmark on days when you do drink." The main problem arising from recommended limits is implicit in the emphasis put on the fact that these "are not targets to drink up to - it's about how much alcohol your body can cope with on one day without any risk to your health."

Having discussed safe quantities and the pleasure associated with consumption, On-line goes on to a section called "Effects of drinking too much". Visitors to the site are warned that these are raised blood pressure, weight gain, accidents, liver damage, cancers of the mouth and throat, digestive problems, problems in pregnancy, and psychological and emotional problems.

"Health benefits"

"The health benefits of alcohol" are stated immediately afterwards. It is perhaps unfortunate that benefits are explicitly mentioned in the heading of the section whilst the damage done by alcohol to health are more neutrally described as "effects". "Studies have shown that people who regularly drink small amounts of alcohol tend to live longer than people who don't drink at all," says the text. "This is because alcohol helps prevent coronary heart disease. Alcohol influences the amount of cholesterol in the bloodstream, and makes it less likely that clots will form." The second half of this message is that "this protection is significant only when you reach a stage of life when coronary heart disease is likely to be a risk. For men this is over the age of 40 and for women it is after the menopause. The health benefits come from regularly drinking small amounts. The maximum benefit is achieved by drinking between 1 and 2 units of alcohol a day."

As an afterthought it is mentioned that "if you don't wish to drink alcohol there are other things you can do to reduce the risk of coronary heart disease. Stopping smoking, eating a healthy diet and taking regular exercise can also make a big difference."

The section on changing drinking habits is useful and the advice is clearly expressed. The simple style adopted by the authors of the text is often inadequate to a complicated idea but is effective when setting out the six steps suggested for cutting down.

Useful tips

Those users of the site who believe that they might have a problem with alcohol will find the tips set out in Step Four particularly useful.

Step 4 Try low alcohol or non-alcoholic drinks instead of alcohol sometimes. Make your alcoholic drinks last longer with mixers or water. Drink more slowly, pace your drinking and take smaller sips. Avoid binge drinking - try to avoid rounds of drinks, or when it's your turn to buy, get yourself a soft drink. Remember that eating crisps and nuts will add to the calories and fats you are consuming. Salty foods also make you thirstier. If you have drunk too much, don't drink for 48 hours afterwards to give your body time to recover. Eat before you drink, so you don't miss out on essential nutrients and slow down the effects of the alcohol. Work out a reasonable drinking limit for any day when you drink - and stick to it. Reward yourself - you should be pleased with yourself when you meet your targets. Buy yourself something special with the money you've saved by drinking less.

The site, given that access to the Internet which such a large part of the population now has, may have considerable benefits. Many people with an alcohol problem, or simply the nagging feeling that they ought to look at their habits, will visit the site far more readily than they will discuss their drinking with a doctor, a family member, or a friend. However, the vital point is made that "if you continue to find it difficult to cut down, you should seek help from your doctor or a specialist agency. They can help whether you are concerned about your own drinking or someone else's."

The next sections are concerned with reasons to cut down on drinking -social, economic, emotional, and medical - and with "What alcohol is and what it does"

The final section is called "Helping someone to help themselves [sic]". This contains vital advice and information for those people who are affected by another's drinking. It gives some useful suggestions based on "things other people in your situation have tried". These include:

Talk to the person you're worried about. Find a time when they are sober and you are calm. Tell them about the problems their drinking is causing. Avoid getting into arguments even if the drinker is being confrontational. It will make it more difficult for them to talk openly to you about things in future. For the same reason it's best not to sound as if you're 'having a go' or 'nagging'. Help the person who is drinking to be realistic. Don't encourage them to make promises they can't keep. The promise "I'll never drink again" is difficult to keep. Help them to set reasonable goals that they can easily achieve. Don't make it easy for them to drink by buying alcohol for them, giving them money, or always agreeing to go to the pub. It may be difficult to break these patterns, but they're more likely to take you seriously if your actions match your words. Don't try to cover up the effects of the drinking - for example by phoning work with excuses, clearing up the mess, putting them to bed, missing social events for fear of embarrassment. Helping the person to see the effects of their drinking might encourage them to change more quickly. Agreeing a consistent approach with other family members or friends will help the drinker to see the problem more clearly. Don't expect changes to happen overnight. But by helping someone realise that their drinking is a problem, you are starting them on the path to cutting down or stopping.