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Executive stress and drinking – a guide for GPs

By Dr Declan Leahy, Consultant Psychiatrist at Priory Hospital Chelmsford

As a society, we are working harder and longer than ever before. The pressures and demands of work are no longer confined to the ‘9-5 world’ and many of us are contactable anytime, anywhere. The increasingly globalised economy, ambitious company targets, the desire to move up the corporate ladder, and a myriad of other modern-day stressors, can mean that our workforce is feeling the pressure like never before. At the helm of this workforce are executives – and this high-earning group are currently out-drinking the rest of the population. It’s not just pressure situations that can lead executives to drink; as a culture, workplace relationships and business development can also be centred on ‘boozy functions’.

Understanding the problem

According to Office of National Statistics (ONS, 2018) data, 7 in 10 people working in managerial and professional occupations drank alcohol in the preceding week. This is compared to just over 5 in 10 people in routine and manual occupations.

Moreover, almost 4 in 5 people earning over £40,000 per year, reported drinking in the preceding week (ONS, 2018).

As these statistics demonstrate, many of the country’s executives have incorporated regular drinking into their busy lives.

Why?

Potential reasons for these levels of drinking amongst executives include:

  • Drinking to relieve stress after a hard day
  • A culture of business lunches and dinners involving alcohol
  • Having disposable income to spend on alcohol

Unfortunately, while in the short term alcohol may seem to relieve stress, it is actually a depressant, and in the long term can contribute to feelings of depression and anxiety, as well as a wide range of physical health problems.

How can GPs identify those at risk?

GPs are often the first point of contact for people’s health concerns, and as such, are in a prime position to help identify those at risk of substance misuse. Techniques GPs can use include:

  • Opportunistic screening during GP appointments, or patient questionnaires about alcohol
  • The CAGE questionnaire which assesses whether somebody may have an alcohol problem. Questions are:
    • Have you ever felt you should Cut down?
    • Have people Annoyed you by criticising your drinking?
    • Have you ever felt Guilty about your drinking?
    • Have you ever needed an ‘Eye-opener’ drink first thing in the morning?
  • Prompting patients to recognise changes or increases in alcohol consumption – trends to more dependent drinking patterns, such as having no alcohol-free days; drinking for emotional reasons; or drinking to self-medicate
  • Prompting patients to recognise when emotional problems such as anxiety, mood disorders, and insomnia may be consequences of alcohol consumption
  • Alerting patients to the link between alcohol consumption and physical symptoms or disease
  • Calculating weekly alcohol unit consumption, and comparing with published guidelines and social norms, which can be instrumental in helping the individual to recognise the need for change

What advice can GPs give?

Having conversations with patients about addiction issues can be particularly difficult. The following advice can help GPs provide their patients with strategies to address their addiction:

  • Alternative stress management strategies – there is an evidence base for all sorts of different stress management methods including exercise, listening to music, breathing exercises and mindfulness activities. Some complementary therapies, such as meditation and acupuncture, also have proven benefits
  • Opting to only have an alcoholic drink with dinner to avoid drinking all evening, delaying alcohol use until later in the evening, and avoiding drinking at business lunches or substituting for lower strength drinks
  • Alcohol tapering regimes can also be used – an initial commitment to a couple of alcohol-free days per week can gradually lead to reducing alcohol consumption further
  • Substitution for lower strength beverages – changing to lower alcohol-by-volume (ABV) beers/wines from current higher ABV drinks can reduce total alcohol consumption significantly and help to reduce harm
  • Further self-help advice can be found on the Drinkaware website. GPs may wish to direct patients there for further information

When and where to refer your patient?

While all the above are useful strategies that can be used, it is important to know when to refer your patient on to specialist addiction services.

Recognising the symptoms of moderate-to-severe alcohol dependence can help with this and include:

  • Physiological withdrawal, including sweating, tremor, anxiety, vomiting
  • High tolerance
  • Preoccupation with drinking
  • Strong compulsion to drink
  • Continuing to drink despite evidence of harm
  • Social or occupational activities given up or reduced
  • Inability to stop drinking

It is also important to consider the need for an assessment and treatment of a co-morbid psychiatric disorder along with the need for medication strategies.

Dr Declan Leahy works at Priory Hospital Chelmsford, which is part of Priory’s network of addiction services which provide inpatient, day care and outpatient support, as well as detoxification, to those with alcohol dependence (along with other addiction issues).

References

NHS, Statistics on Alcohol England, 2018, May 2018

Office of National Statistics (ONS), Adult drinking habits in Great Britain: 2017, May 2018

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