Alcohol and Alcoholism Advance Access originally published online on June 14, 2008
Alcohol and Alcoholism 2008 43(5):589; doi:10.1093/alcalc/agn049
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Alcohol Abuse Among English and French Psychiatric Referrals from Accident and Emergency Departments
1 Swanley CMHC, 17 High Street, Swanley BR8 8AE, UK
2 Psychologist Centre Hospitalier Saint-Philibert, Service des Urgences, BP 249, 59462 Lomme cedex, France
* Corresponding author: Swanley CMHC, 17 High Street, Swanley BR8 8AE, UK. E-mail: masarfraz{at}aol.com
Received 12 November 2007; ; accepted 23 May 2008
Despite cultural and historical differences, France and England today face similar levels of alcohol-related morbidity and care burden (European Commission, 2007
). Accident and Emergency (A&E) departments and psychiatric services are at the forefront of detection and treatment of alcohol abuse in both countries. We noted the absence of collaborative interventions regarding alcohol-related harm in both countries and carried out a comparative study to highlight characteristic of those who abuse alcohol among psychiatric referrals to inform future policy and interventions.
We screened all patients referred for psychiatric assessment at the A&E departments of two general hospitals in catchment areas which were similar in their size and socioeconomic characteristics, Dartford (UK) and Lille (France), between April 2007 and July 2007. All patients were screened for demographic details, reason for referral, clinical diagnoses and outcome according to a questionnaire (Sarfraz and Castle, 2002) containing CAGE items for detecting alcohol abuse. There were 116 patients referred during this period (72 of whom were male); response was 100% because the questionnaire formed part of the routine psychiatric assessment. English (n = 47) and French (n = 69) samples were similar in terms of average age (39 years), gender distribution and sources of referral. However, alcohol abuse (CAGE > 2) was commoner among English subjects especially in the group aged 15–45. We also found that among those who abused alcohol, French patients were more likely to be single, and referred because of a risk of self-harm and/or drug and alcohol abuse. There was a less chance of follow-up after psychiatric assessment in Dartford than in Lille.
This pioneer study replicates findings of national studies (Chastang et al., 1997; Hearne et al., 2002) and highlighted important characteristics of English patients who abused alcohol: lower referral rate to future intervention, younger age group, severe alcohol abuse and less chance of a psychiatric follow-up. While the evidence for English youth and binge/severe drinking is well documented, low referral rate and follow-up may reflect different structure of local services. Drug and alcohol service is a part of mental health services in Lille, but in Dartford, like elsewhere in England, this service is independent and tends to depend on self-referral. This may also explain, albeit partially, the lower frequency of drug and alcohol abuse as a reason for referral in Dartford as some of these patients would be assessed at the A&E and discharged with advice regarding self-referral to drug and alcohol service without referral to psychiatric or NHS substance misuse services. It may also reflect the absence of integrated services for dual diagnosis as proposed by the English government.
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European Commission. Report: Alcohol in Europe (2007) http://ec.europa.eu/health-eu/news_alcoholineurope_en.htm (9 May 2008, date last accessed).
Chastang F, Rioux P, Dupont I, et al. Enquête prospective sur les tentatives de suicide. Encéphale (1997) 23:100–4.[Web of Science][Medline]
Hearne R, Connolly A, Sheehan J. Alcohol abuse: prevalence and detection in general hospital. J R Soc Med (2002) 95:84–7.
Sarfraz MA, Castle D. Alcohol misuse among elderly psychiatric patient referrals. Am J Geriatr Psychiatry (2002) 10:758–9.[CrossRef][Web of Science][Medline]
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