Essay
Clinical Placement Example Essay
- Module
- Clinical placement
- Institution
- The University Of Birmingham (UBir)
Essay of 2 pages for the course Clinical placement at UBir
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For all people seeking help for alcohol misuse, NICE recommends that health professionalsgive information on the value and availability of community support networks and self-
help groups e.g. Alcoholics Anonymous. Evaluate the evidence for this advice.
NICE guideline CG115 is designed to help successfully treat "Alcohol dependence and
harmful alcohol use," stating-
"Give information on the value and availability of community support networks and self-help
groups... and help them to participate...by encouraging them to go to meetings and
arranging support so that they can attend."(1)
In this essay I will focus on the idea that self-help groups are beneficial for treating alcohol
dependence and the concept that brief alcohol intervention within primary care is an
appropriate setting for this advice to be given.
The Journal of Substance Abuse Treatment investigated this issue, publishing a report in
2004 (2) that evaluated the importance of self-help organizations. One of the first
observations made was that the attitude of the doctor towards these schemes was very
important in encouraging participation, with a positive attitude showing a marked increase
in the number of people affiliated with a self-help group; thus supporting the guideline
recommendation of encouraging patients to attend when possible. Furthermore, research
gathered following 887 alcohol dependant patients showed that after one year those
attending a self-help group were significantly more likely to be abstaining from alcohol, less
dependent on other healthcare support and had reduced their medical bill by $5000 a year.
A similar study was then repeated, placing emphasis on those patients that engaged best
with the program, and again an improvement was seen against the control; while another
study showed improvements in enhanced self-efficacy, social support, reduced depression
and effective stress management. All of these results serve to reinforce recommending self-
help groups and community support. However, this report also serves to highlight the
potential negatives of such advice, suggesting that self-help groups may foster unhealthy
dependence and reduce autonomy. Likewise, it is clear that offering this advice to every
patient, without taking into account their unique situation is likely to have a negative
impact. Ethnicity, sexual orientation and religious beliefs must first be considered before a
recommendation is given to avoid patient discomfort and maximise the probability of
success.
A second article (3)published in The Journal of the American Medical Association
summarised the finding of a systematic review that looked at whether alcohol consumption
was reduced by brief alcohol intervention (BAI) in primary care- an issue that is very closely
linked with this specific NICE guideline. Analysis and meta-analysis of 612 studies showed
that on average BAI leads to a 38g decrease in ethanol consumed per week. Likewise
researchers found that these results were still present at both six and twelve months with
no obvious decrease in effectiveness, with patients also benefiting from fewer medical
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