Problem drinkers who could be helped following admissions to hospital are "falling through the net" due to the "completely random" nature of specialist services in different parts of the country, according to new research.

A review of alcohol services in Scotland's acute hospitals found that more than half had a no specialist service at all for problem drinkers or only "limited" support.

The number of people dying as a direct consequence of alcohol misuse in Scotland has been climbing steadily over the past decade and reached a 14-year high of 1276 deaths in 2022.

The Scottish Government is expected to announce an increase in the rate of minimum unit pricing on Thursday - a move backed by public health experts and alcohol charities - but clinicians said more could be done to identify dependent and harmful drinkers in hospital.

As well as being strongly associated with liver disease, excess alcohol consumption increases the risk of heart attacks, falls, high blood pressure, and some cancers.

Dependent drinkers - those who would suffer withdrawal symptoms if they suddenly cut down or stopped drinking - make up one in 100 of the general population but one in 10 hospital admissions, while those consuming alcohol at harmful levels are around five times more likely to require medical care compared to the population at large.


Speaking to the Herald, Dr Alastair MacGilchrist, a retired consultant hepatologist and chair of Scottish Health Action on Alcohol Problems (SHAAP) - which commissioned the review - said: "Setting liver disease aside, you've got 100 people a day in Scotland who are being admitted to hospital because they've been drinking too much. That's quite a lot of folk.

"And beyond that, you've got the folk admitted to hospital for other reasons who might be drinking too much and it's an opportunity to catch them, to talk to them about it and help.

"We know that the prevalence of high levels of drinking is much higher among hospital patients than it is in the general population - four or five times higher - so it's a very efficient way to do it.

"But we've never had a systematic approach in Scotland as to whether we should use hospital admission as a potential identifier.

"It's such a missed opportunity - falling through the net is a good way to put it."

The Herald: Dr MacGilchrist, a liver specialist, said there was a 'missed opportunity' to catch problem drinkers in hospital while admitted for other reasonsDr MacGilchrist, a liver specialist, said there was a 'missed opportunity' to catch problem drinkers in hospital while admitted for other reasons (Image: SHAAP)

SHAAP commissioned research to find out, for the first time, how alcohol services vary across Scotland's 32 acute hospitals.

Frontline staff, including liver specialists, psychiatrists, and addiction nurses, were also interviewed.

Dr Gilchrist said the findings uncovered a "classic 'postcode lottery' with alcohol services in hospitals revealed to vary from suboptimal to non-existent with no consistent approach to funding or practice". 

He added that increased investment would ease pressure on the NHS by reducing re-admissions and health problems caused by alcohol. 

Of the 20 hospitals which responded, three - the Belford in Fort William, Dr Gray's in Elgin, and Perth Royal Infirmary - reported having "no service specifically for problem drinkers", while eight, including Raigmore in Inverness, said they had a "limited" ad hoc service.

Only nine reported having an established specialist service, including at Ninewells in Dundee and Edinburgh Royal Infirmary.

The research also found surprising variations between neighbouring regions, with Borders General employing the equivalent of one specialist alcohol nurse for every 113 beds compared to one per 1,053 beds at Dumfries and Galloway Royal Infirmary.

The Herald: Breakdown of responses by hospitalBreakdown of responses by hospital (Image: SHAAP: 'A Review of Alcohol Services in Scotland's Acute Hospitals', Jan 2024)The Herald: Ratio of specialist alcohol nurses to beds, by hospitalRatio of specialist alcohol nurses to beds, by hospital (Image: SHAAP)

"Borders has got a great service - Dumfries and Galloway has hardly any," said Dr MacGilchrist.

"That's not to single them out, it's just to show that it's completely random.

"Often it's down to the enthusiasm of a local doctor - it's somebody's particular interest, or one particular health board has decided to commit funding to that.

"There's no directive on the health board as to whether they should employ alcohol nurses or not, so it's completely random."

Of the hospitals providing a specialist alcohol service, just over half had secured funding from their local Alcohol and Drugs Partnership while the rest were reliant on money coming from hospital budgets.

In some areas this funding is said to be "on a knife-edge" as health boards look to cut costs.

The survey also highlighted inconsistencies in whether patients were screened for problem alcohol consumption at all, even among referrals into liver and gastroenterology units.

Where patients were identified with alcohol use disorder, some hospitals would automatically refer them onto an alcohol services while others would take no action.

Feedback from frontline staff found that alcohol was seen as "neglected" compared to drugs within substance misuse teams, while a specialist alcohol nurse described how patients with problem drinking tended to be referred on once they had been in hospital for three or four days already and "because of bed pressures, these patients then get discharged, without anything in the community, so it's a revolving door".

The Herald: Alcohol-specific deaths in Scotland during 2022 were at their highest since 2008Alcohol-specific deaths in Scotland during 2022 were at their highest since 2008 (Image: NRS)

The report noted that "heavy reliance" on community-based alcohol services to manage patients post-discharge was also a "potential pitfall".

Dr MacGilchrist said: "Community services are extremely stretched. There's a great danger that even if you have an alcohol care team in hospital, it stops at the front door.

"In an ideal world you'd refer on to the community care team, but sometimes it's just a case of 'call this number' and there's no reply or it's 'we'll see you in three weeks time' and by that time they're drinking again.

"So there's this chasm between identifying them in the hospital and continuity of treatment once they go home. That's a huge issue."

A spokesman for the Scottish Government said it was "determined to do all we can to reduce alcohol-related harm" had made £106 million available to Alcohol and Drug Partnerships in 2022/23, rising to £112m in 2023/24.

He added: “We are continuing to work with the UK Government on developing new UK-wide clinical guidelines for Alcohol Treatment.

"This guidance will look to introduce new approaches to treatment and will apply to a broad range of settings including primary care, hospital and justice.

“In addition to this we are engaging with stakeholders to consider feasibility and options to develop alcohol treatment standards specific to Scotland.”