Opinion

Drunk: the impact of alcohol abuse on our health care system

Defined as someone “having the faculties impaired by alcohol” (or a more practical version: “When you have to hold onto the grass to keep from falling off the earth“), those of us who work in an acute healthcare facility are witness to many illustrious examples of drunk patients coming through our doors.

Underaged kids passed out at a house party? Yup. Raging alcoholics who are brought into the ER at least once a week? Sure. Elderly women who secretly binges on wine at home and falls down the stairs repeatedly? You betcha. What they all have in common is an apparent complete oblivion/ignorance to the source of the problem, and the associated ill effects on themselves.

Sometimes I wonder if the healthcare/political/legal system itself is “drunk”, in its own oblivion and inaction towards the impact alcohol abuse is having on our society.

The average sober Canadian would be shocked to hear of the types of alcohol-related ER visits that come through a hospital’s doors every weekend.

Empirical data supports this theory of absurd and inefficient healthcare dollar usage on alcohol abuse related hospital visits. As reported in the Recommendations for a National Alcohol Strategy published in 2007, “the economic impact of alcohol-related harm in Canada totaled $14.6B, taking into account the costs associated with lost productivity, health care, and enforcement. This amount is slightly less than the estimated cost of tobacco at $17B, but nearly double the cost attributed to illegal drugs at $8.2B”.

Anecdotal evidence reports many unnecessary ER visits where drunk patients simply take up an acute care bed for the night to sober up, eat a free breakfast in the morning and then get discharged. It is estimated that 0.6% of all U.S. ER visits are made by people who have no other problems beside being drunk, translating to over 900 million dollars just for ER visits alone.

For a Canadian flavor, a recent study pegs healthcare costs related directly to alcohol abuse as exceeding those of cancer – the researchers estimate roughly an annual cost of $463 per Canadian, easily over $1 billion a year.

In an effort to combat this surprisingly ingrained epidemic, new protocols and methods are being examined to divert unnecessary visits to the ER. For example, researchers in Colorado are working on a simple checklist for prehospital personnel to decide whether patients can go straight to a detox center to sober up, rather than taking up a scarce ER bed. In Cardiff, Wales, they have taken an even more innovative shock-factor approach of videotaping drunken behaviors upon patients’ arrivals and then showing the footage to them once they are sober.

None of these bandage solutions are tackling the underlying problem.

Even though alcohol plays a role in a significantly large chunk of our healthcare resource utilization, it still gets relatively weak attention compared to controlled substances that arguably have a much smaller impact on our overall society (e.g. the recent media frenzy around Health Canada’s approval for a generic version of OxyContin). Alcohol use has become so deeply rooted in North American culture that even admitting it is a societal problem is difficult…but then again, so was smoking.

Maybe it is time that, as a society, we overcome the denial stage and stop turning a blind eye to the tremendous toll of alcohol-related healthcare spending. Only then can we start thinking outside the box to work on sustainable and practical solutions.

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5 Comments
  • janice watkins says:

    all alcohol is a carcinogen and causes over 7 cancers and over 200 other medical conditions it is alarming how our government and health care system is keeping this information from the public the government knows the harms from alcohol and that it is the deadliest drug out there and yet they promote it to be sold everywhere they are more concerned about opiates killing people then alcohol and the main reason is money our government is too buddy buddy with the alcohol companies all alcohol products must be labelled, alcohol is linked to fasd in babies and yet 9 out of 10 women don’t know about the harms alcohol causes and more women then ever before are drinking all of our government, health organizations, doctors, nurses, cancer agencies, and anyone involved in health should be making it breaking news every day that alcohol causes cancer and is killing people more money is spent on alcohol health issues then any other drug

  • Fred Scarfe says:

    #alcoholawareness Absolutely alarming-Alcohol is a group 1 Carcinogen-No safe level of consumption,including wine,beer or liquors.Leading cause of Cancers/diseases and over 200 conditions and top health and safety threat-Leadership and system massive failure to protect public health and safety and community and the harm costs far exceed revenues and thus harms the economy too-Millions die every year and millions more damaged and suffering-We call for National leadership and coordinated comprehensive strategy to reduce consumption availability deaths disability and illness and costs to taxpayers. Sincerely Fred Scarfe Director JMF Research BC-Alcohol

  • Kathy Kilburn says:

    I am concerned about the tone of this article.

    The first paragraph is flip and dismissive. Aside from the contemptuous ‘definition’ of drunkenness, would you refer to an influx of trauma patients as “illustrious”?

    The second paragraph is worse. You may have missed the lecture outlining the fact that people who are impaired by alcohol or other substances are, pause, impaired. Their judgement is not what it should be, and of course it’s worsened by age and progression of the disease–you did get to the lecture that define substance use problems as a disease, yes?

    The healthcare/political system that you condemn suffers from the same discriminatory attitudes that you demonstrate: substance use problems are consistently and universally under-served, receiving the least amount of funding support by a long shot. Attention to substance use problems is diluted by division among nearly every Ministry in government, federal or provincial, with absolutely no overall vision, and absolutely no coordination. Policies conflict with each other, and god help the person who is under the ‘care’ of more than one Ministry’s agencies.

    ERs are infamous for their stigmatizing behaviour towards people with substance use and mental health problems: you may want to check out another discussion on this site
    http://healthydebate.ca/opinions/my-experience-with-stigma-within-the-health-care-profession

    I have worked in the field of addictions for over 20 years, at an indirect level. I can’t tell you the number of times one of the agencies I’ve worked with has approached a hospital and offered, at no charge, to have an addictions worker present in the ER to address the needs of impaired patients, who are appallingly served by the TSAS–only to have that offer refused because, “after all, it’s their choice”. It’s not clear to me how that type of response serves either the over-burdened ER or the patient.

    Ontario has been, for decades, the developer and disseminator of the social detox model. Under this model, the impact on medical services is minimal–people who are intoxicated are, by and large, served by detox staff, rather than being hospitalized or jailed. Ontario also investigated community withdrawal management services as a model for moving care even further out into the community, closer to the service user. These services are low-cost and high-quality; there are few of them in the province, and they have not received the level of funding they require to do the kind of job that would reduce negative impacts on hospitals, ERs, jails, other social and health services, and, dare I say most importantly, the substance user and his/her circle of friends and family. The kind of checklist you mention is well established, and has been in long use in Ontario.

    People with substance use problems don’t want to be in your ER beds, unless they have a physical health care problem that needs attending.

    You offer no clear and pragmatic solutions to the overall problem; you imply that attention needs to shift from the comparatively minor harms of controlled substances to alcohol. In order for that to happen, the fear-mongering common among politicians and the media regarding “street drugs” would need to stop.

    More to the point, societal–including professional–attitudes towards people with substance use problems would need to change from one of judgement, stigmatization and discrimination, disdain and censure. This is a health problem, and it must be responded to *as* a health problem. If we have learned anything from two centuries, at least, of earlier responses to substance use problems, it’s that contempt and condemnation are inappropriate and, to say the least, counter-productive.

    If you want to solve the problem, start by looking at your own attitudes and behaviours.

    • Concerned Nurse says:

      it is a problem and a huge $$$$ drain on the healthcare system. I see it as a healthcare worker and it’s not just ER visits have you ever heard of WET BRAIN look it up! It is horrible…I have seen my 31 bed floor being half taken by WET BRAIN patients. That is just one lil unit in a hospital needless to say there are many others on the other units. The cost to care for these patients is extensive and they nearly never recover to a functioning adult again so they linger in hospital beds waiting for a nursing home!! sometimes for over 2 years!!!! So as a smoker i have watched the price of my smokes triple in the last 15 years cause smokers are such a drain on healthcare which is fine….but I would also like to see the price of alcohol triple to help with the associated healthcare cost!

  • dave higgins says:

    Thanks very timely comment- additional impact which I am sure you see a lot in your role is is the role of alcohol in violence of all kinds from spouse abuse, brawls, assaults and manslaugher/murder. The comorbid impact of addiction to alcohol mainly but also other substances in patients suffering from mental illness is also often unrecognised and definately under treated. I like your comment with respect to tobacco which now is regarded with much less social acceptance than in previous decades. There is some pretty good data emerging on prevention of excessive alcohol use in younger kids and in extending the age of onset of drinking which seems to have important impact on brain development and later behaviour. Agree it is time to get focused and engage as a profession with public health and government to lead a strategy -could be powerful if we agreed on a major focus whether prevention, palliation of end stage disease, early intervention- (whatever -but make it “do-able” !) and moved forward- we so often get paralysed by the enormity of the problem and the wish to fix everything.

Author

Edmund Kwok

Contributor

Dr. Edmund Kwok is an Emergency Physician with special training and interest in performance management, quality improvement, and patient safety. He blogs at the Front Door to Healthcare.