Table 2 Appeal to pharmacists of considering alcohol as another drug

It hadn’t occurred to me before, but it is a drug … I mean, the people on anti-depressants, people with anxiety those kind of things, it’s something to think about … whenever I speak to anyone with depression or anxiety, it’s probably worth asking about alcohol as well … I absolutely agree that it’s within our purview … I’ll confess to, I certainly don’t make it my priority in many conversations, but I do like the aspect of treating it like a drug … I like the idea of linking it to the various conditions, and linking it to medicine interactions … I’ve always found diet and exercise to be more important … I couldn’t give you a solid answer as to why alcohol was less important … I could certainly hear a case of it being made in diabetes, in depression, in any sort of opiate treatment. But then … to a lesser extent, in any sort of cardiovascular illness, any sort of renal illness, or like, obviously liver problems … I can certainly hear a case being made for it being a drug (3)

I understand what you’re saying because it is a drug … It’s a funny thing [not seeing it as such] … I don’t think it’s because it’s not important because I think it’s very important. I think the focus is always on review the drugs, review the medication. But that is not being perceived to be one, is it? So therefore it’ll only come into the conversation if it becomes a problem … it’s another drug that people don’t see as a drug … They see it as a … it’s just a glass of wine, or a gin every night (2)

… have we got specific resources for pharmacists on the effects of alcohol on the various conditions that we could learn from and use as part of a tool to discuss with patients? Because as much as we all have ideas of the impacts of alcohol … [it’s] not necessarily something that immediately comes to the forefront of my mind, unless it's somebody that's got significant resistant hypertension. So something like that, if it exists, would be great and I would love to know where that is and if not, why doesn’t it exist? … generally when I'm doing structured medication reviews, I … have … the healthy lifestyle bit on the end … So we do all the meds and the diseases and actually that’s a point is that we don't necessarily feed that in, it becomes like the add-on at the end to cover (4)

I think it gives you another lever in to talk about it and, I'll be honest, it's not something I'd considered picturing it on the end of the prescription as ethanol rather than a drink. That's a very interesting way of looking at it … often when people are talking about their medicines they're wanting to know what are the side effects, how is this going to harm me, is it going to or what are the benefits of it? So really if you get to ethanol you can say, well, the side effects or the toxicity can be this, this, this and this, benefit … it might make you feel nice at the time for a short period but … my ears have really pricked up … I think that actually would perhaps have more of an impact on the way somebody thinks about it than the worry of addiction, because I think addicts it’s a different mindset I guess. Whereas if you say … you’re taking this drug ethanol regularly, it does have toxic effects, it can increase the risk of cancer, of heart disease, of diabetes, of all the rest of it, dementia, list all these horrible things that can happen and just make sure that is very much in people’s minds. And that would hopefully encourage them to reduce their intake (10)

[That] definitely resonates with me … especially with a lot of the elderly … population who are on multiple drugs … it can affect their overall quality of life, because they’re not getting the best from their medications … I think we need to almost start targeting that area … for me personally, it is about the ones who don’t think that they’re drinking a lot, that’s the hardest one … ‘oh, I only … have a glass when I’m cooking, I maybe have a glass with my dinner, but I don’t really drink a lot’, I get to hear that quite a lot … I think alcohol’s going to be an issue … even in the more affluent areas … but the areas where you’ve got … more deprivation, I suspect …you’re going to struggle more … they would be the ones that you would need to look at, particularly where you’ve got younger families … (X8)

… it’s having indigestion every day, that could lead to problems with your oesophagus, it’s … your bowel habits not being right and … doesn’t have to even be as deep as your blood pressure medication. And most of all, what it does to your mental health and your sleep … Especially, if you’re looking at [it]… as another drug … we ask people if they buy any medicines, over the counter, antihistamines, painkillers, whatever. So, why shouldn’t we ask them what their intake of alcohol is? … you’ve given us a lot to think about actually then next time I ask somebody how much they drink (5)