I look after patients admitted to A&E for all sorts of medical reasons, who show signs of using alcohol or other drugs. Worcestershire Royal Hospital is an acute hospital, so people won’t be in our A&E for detox, but withdrawal symptoms can be life-threatening, which is where I come in. When someone presents to A&E or is admitted, I chat with them to find out how much alcohol they’re drinking and how often, whether they experience withdrawal symptoms, seizures or DTs (delirium tremens) to determine whether they have an alcohol dependence. Then I’ll start them on medication to make sure they stay safe while they're with us. When people are ready, we also talk about the psychological reasons behind why they drink, what they can do to help themselves and the support that I can offer.
People who are dependent can’t just stop cold turkey, as this could lead to serious or fatal alcohol withdrawal. We don’t have the capacity to keep people in hospital for detox alone, but I have outpatient appointments and help patients reduce their intake slowly and safely. If people are showing up, and are willing to change, I’m more than happy to help, even through daily phone calls. I have a good working relationship with community drug and alcohol services and with people’s consent, I will refer them on so they can gain that extra support. I also have good links with AA (Alcoholics Anonymous) and a contact who will help people find a sponsor or someone who can take them to their first meeting, because going in alone can be so daunting. We really need better access to rehab. I know funding is tight, but people are missing out on treatment at critical times.
"Most of the time, people know they need to stop drinking alcohol, but it’s really difficult to do that because of how easily accessible alcohol is."
Most of the time, people know they need to stop drinking alcohol, but it’s really difficult to do that because of how easily accessible alcohol is.
The way we access alcohol has changed dramatically, especially after COVID-19. With just a few taps on a smartphone, alcohol can be delivered to our doorsteps, no questions asked. While this convenience may suit many, it poses a serious risk to people struggling with alcohol dependency. When I started working as an Alcohol Liaison Nurse in 2021, it became clear to me, very, very quickly, that delivery services like Uber Eats, Just Eat, and Tesco Whoosh mean that you can get alcohol at two, three, four, whatever o’clock in the morning.
"As long as there’s a shop open that sells alcohol, someone will deliver it, and quickly. I have seen an alarming number of patients increase their intake or relapse because of how accessible alcohol now is."
As long as there’s a shop open that sells alcohol, someone will deliver it, and quickly. I have seen an alarming number of patients increase their intake or relapse because of how accessible alcohol now is.
Quick and easy access to alcohol can derail recovery, worsen mental and physical health problems, and lead to repeated hospital admissions. I’ve seen patients from as young as 19 deteriorate in front of my eyes and sadly die due to alcohol harm. The youngest person I detoxed was 21, drinking a litre of vodka a day and many of my patients are in their 30s and dying from alcohol related conditions.
When I chat with people, who are often very vulnerable, I always ask where they get their alcohol. This isn’t necessarily common practice, but it makes sense to me as a lot of my patients do not, or cannot, leave the house. If their carers are bringing them alcohol, that’s a safeguarding issue. However, most of my patients say they get alcohol delivered.
Online alcohol delivery services give even very vulnerable people, including those who don’t or can’t leave the house, a very quick and easy way of accessing alcohol. One of my patients said that if they didn’t have that access, they wouldn’t drink alcohol, because they wouldn’t leave the house.
"The rise of alcohol delivery services removes critical barriers that once gave people time to reconsider – barriers like walking to a shop, facing social scrutiny, or interacting with a responsible seller."
The rise of alcohol delivery services removes critical barriers that once gave people time to reconsider – barriers like walking to a shop, facing social scrutiny, or interacting with a responsible seller.
I also ask people whether they’d use an option to stop themselves from receiving alcohol deliveries, and most say yes.
"Just as we can opt out of marketing emails or gambling platforms, people should be empowered to opt out of alcohol delivery services."
Just as we can opt out of marketing emails or gambling platforms, people should be empowered to opt out of alcohol delivery services. A model for this already exists. GAMSTOP is a free service that lets people put controls in place to stop them from gambling. You can choose how long you have GAMSTOP on: six months, a year, five years, or five years with auto-renewal. Why can’t we have a similar option for alcohol?
Having a similar system for alcohol deliveries would allow vulnerable people, people in recovery, people with mental health challenges, or people simply trying to cut down, to take control of their environment. Allowing individuals to block alcohol deliveries to their address will create a protective barrier against relapse and excessive consumption.
"An opt-out for deliveries, an individual-level change, could really help reduce alcohol harm, prevent relapse, and possibly stop addiction before it starts."
An opt-out for deliveries, an individual-level change, could really help reduce alcohol harm, prevent relapse, and possibly stop addiction before it starts. This option would need to be available only to people who are safe to stop drinking entirely, because people who are dependent cannot just stop. There could, perhaps, be a requirement that it is activated only by professionals, giving a newly detoxed person the option to take control of their sobriety and help with relapse prevention.
Every day, I see the impact of alcohol on people’s lives, and on the lives of those around them. More control over alcohol deliveries, as a tool to support themselves through active addiction, and better access to treatment, can make a huge difference. Why not give people another tool they can use when they’re already asking for help?
