Alcohol misuse: how to have a crucial conversation

For many people, drinking alcohol is often thought of as a way to unwind and relax, despite increasing evidence to the contrary.

A report by the World Health Organization revealed that drinking can increase your risk of depression and anxiety, liver cirrhosis, pancreatitis, suicide, violence, and accidental injury.

In England and Scotland, it’s estimated around 25% of adults regularly drink over the government’s recommended health guidelines with around 600,000 people dependent on alcohol.

“This is a taboo subject for nursing staff as we’re often seen as people who are strong,” says chair of the RCN Mental Health Forum Ellie Gordon. “It’s possible many nursing staff are struggling in silence with their alcohol consumption or may even feel they’re in control of their drinking but are unaware they’re building an unhealthy habit that could lead to health issues and even affect their job.”

This is an area steeped in stigma

Ellie suggests starting conversations around alcohol in a relaxed and non-judgemental way, especially if a colleague has been particularly stressed or has said they’re feeling anxious or overwhelmed.

• Read next: How to support nursing staff under stress

“Bear in mind that while there is more help than previous generations to address drinking issues, this is still an area that's steeped in stigma and people are invariably reluctant to open up about drinking habits, fearful of the negative consequences that will follow if they do,” adds Ellie.

Ellie’s tips for initiating conversations

• Don’t begin by asking about drinking. Sometimes people get nervous about this conversation and feel targeted which is likely to lead to distress on both sides.
• Start off as any other conversation. Ask how the person is feeling. Are they feeling overwhelmed at all or stressed about work?
• Let them speak. Once the conversation gets going it could lead to disclosure about coping strategies, at which point it might be possible to ask if they’re using alcohol as a way of coping.
• If they say alcohol is a way of coping: ask how often they’re using alcohol, how much they’re drinking each time they do drink, and how they feel physically and emotionally the morning after.
• If they say alcohol isn’t a way of coping: I would suggest mentioning any areas of concern noted by colleagues that initiated the conversation – maybe the person is turning up late or someone mentioned they smelt of alcohol – and see if this elicits disclosure.

If someone doesn’t feel comfortable speaking, there are online tools they can access to assess their level of drinking, and places where they can go for support.

Coping mechanisms

RCN professional lead for mental health nursing Stephen Jones says the pandemic and workforce pressures have taken their toll on nursing staff, leading to an increased dependence on alcohol for people who are feeling stressed.

“Physical health and mental health are interrelated, but we can’t forget the social and cultural elements either,” he says. “Quite often it’s the circumstances in which we find ourselves that contribute to our distress or lead to our coping mechanisms.

“Drinking alcohol is one of the ways people have coped with the pressures of life. During the pandemic there was an increase of people using alcohol and substances in response to stress.

• Read next: Five ways to help beat burnout  

“Although the context of the pandemic is likely a contributing factor for many, we can’t forget the burnout and moral distress that has plagued nursing since before the pandemic. Issues such as staffing levels, inappropriate skills mix and bullying and harassment at work."

Nursing staff should prioritise their own health

Stephen advises nursing staff seek help from a GP or the RCN counselling service if they feel are using alcohol as a coping mechanism.

"There really shouldn’t be any stigma or shame in wanting to seek advice as alcohol is a strong addictive substance, readily available, and nursing staff must prioritise their own health and wellbeing,” he adds.