Alcohol & Medicines: Health Risks

The study focused on 24 individuals residing in the North of England, aged 55-64, who were taking medication for long-term conditions and consumed alcohol at least twice a week. The recruitment process was pragmatic, aiming for a diverse sample within a limited timeframe (March-April 2018). Participants were recruited through pharmacies, with some referrals from pharmacists and others responding independently to advertisements. The study aimed to include individuals potentially eligible for medication reviews, encompassing those taking high-risk medicines such as NSAIDs, diuretics, antiplatelets, and anticoagulants. Although aiming for diversity, the final sample showed limited diversity in terms of ethnicity and sexual orientation, with fewer women than men. This highlights a limitation common to exploratory qualitative studies.

The primary method of data collection involved semi-structured interviews. These interviews explored participants' alcohol consumption patterns, their experiences with concurrent alcohol and medicine use, and their perceptions of related risks and benefits. Transcripts from these interviews underwent rigorous analysis using a modified framework method incorporating constructionist thematic analysis. The researchers used the shortened three-item version of the AUDIT-C (Alcohol Use Disorders Identification Test) to confirm participants' drinking status and the five-item MARS (Medication Adherence Report Scale) to assess their medication adherence. These tools helped determine participant eligibility and provided context for the interview responses. Written consent was obtained, ensuring participant rights, confidentiality, and anonymity were fully protected. This rigorous approach ensured reliable data collection and analysis focusing on the interplay between alcohol, medication, and medication adherence.

To ensure a diverse participant range, the study employed specific screening tools to assess both alcohol consumption and medication adherence. The AUDIT-C score, ranging from 0-12, served as a key indicator of the potential impact of drinking on health and safety; higher scores suggesting a greater likelihood of negative effects. Meanwhile, the MARS scale, with a range of 5-25, measured self-reported medication adherence, higher scores representing greater adherence. Utilizing these two measurements, researchers targeted participants across a spectrum of both alcohol use and medication adherence, aiming to achieve a balanced representation of low and high levels in both categories. This approach facilitated a nuanced exploration of the relationships between these aspects in the context of the study’s focus on long-term condition medication and concurrent alcohol use.

The study revealed a range of alcohol consumption patterns among participants. While most described themselves as "casual," "social," or "moderate" drinkers, their AUDIT-C scores (mean 7.88) indicated a significant number engaged in risky drinking levels. Specifically, half (12/24) of the participants scored between 8 and 11 on the AUDIT-C, suggesting problematic levels of alcohol use. One participant even scored 12, indicating harmful levels of drinking, along with two other interviewees reporting previous treatment for alcohol and/or drug dependence. A significant majority (71%) reported past heavier alcohol consumption, with only a small minority (12.5%) stating they now drink more than previously. These results underscore the prevalence of potentially risky drinking behaviours within this population of older adults using long-term condition medication.

Participants demonstrated high self-reported medication adherence, with mean MARS scores of 23.13 (range 15-25). Despite this high adherence, the study found a notable interplay between medication use and alcohol consumption. Many participants actively tried to separate their alcohol and medicine intake, even if only by short intervals. However, some instances of medication non-adherence related to excessive alcohol consumption were reported. Further, nearly 40% had consulted healthcare professionals regarding alcohol reduction, emphasizing the recognized need for adjustments within their healthcare routine. The study shows a clear link between medication adherence and the reported patterns of alcohol use in the sample, highlighting the potential implications of concurrent use on both aspects.

The findings highlight a discrepancy between participants' awareness of potential health risks associated with alcohol consumption and their actual drinking behaviours. While a majority (54%) acknowledged potential risks, especially regarding interactions with their medication, many continued their current levels of alcohol use. The perception of risk was largely shaped by short-term, embodied experiences rather than longer-term health outcomes, demonstrating a form of 'delay discounting' where immediate rewards (relaxation, improved sleep) outweighed concerns about future health. Participants often located "risky drinking" in the behavior of others who drank more heavily than themselves, demonstrating a sense of personal control and exceptionalism. Risk mitigation strategies included separating alcohol and medicines consumption, choosing lower-strength drinks, and limiting their intake based on personal experience of negative consequences like hangovers. This points to the significance of individual experiences in shaping risk perception and behavior modification concerning concurrent alcohol and medicine use.

The discussion section emphasizes the limitations of current approaches to alcohol risk communication, particularly for older adults managing long-term conditions and taking multiple medications. The study's findings challenge the effectiveness of generalized public health campaigns focusing solely on reducing alcohol consumption. Many participants, while acknowledging some risks, didn't perceive themselves as susceptible to harmful drinking and were largely unaware of long-term health risks associated with concurrent alcohol and medicine use. Their risk assessments were often based on short-term, personal experiences rather than broader health guidelines. This suggests that current alcohol risk communication strategies may not be effectively reaching or resonating with this population, underscoring the need for a different approach to alcohol risk communication for those managing complex health needs.

A key finding highlighted is the phenomenon of 'delay discounting,' where participants prioritize the immediate positive rewards of alcohol consumption (relaxation, sleep aid, pain relief) over potential long-term health consequences. This suggests that the appeal of alcohol for managing the discomfort and uncertainty of living with chronic health problems should be considered in the development of new alcohol risk communication strategies. The study also notes the importance of individual experiences in shaping risk perception and the tendency to compare one's own drinking habits to those perceived as more excessive. This approach, while seemingly self-regulating, does not necessarily lead to adherence to low-risk drinking guidelines and may not account for the cumulative impact of concurrent alcohol and medicine use on medication adherence and long-term health. Therefore a more sophisticated approach to alcohol risk communication is required.

Based on the study's findings, the discussion emphasizes the necessity for a shift in approach to alcohol risk communication. Instead of focusing solely on reducing alcohol intake or emphasizing negative health outcomes, a more person-centered approach is advocated. This involves open dialogue between healthcare providers and patients, personalized discussions acknowledging individual autonomy, and focusing on empowering patients to make informed choices. The study strongly suggests that healthcare professionals should be better equipped and more comfortable addressing alcohol use during medication reviews, assisting patients in making active and informed connections between their medicines, alcohol intake, and their long-term health. This involves a more nuanced understanding of the temporal construction of risk and the influences of social norms on drinking behavior. This enhanced approach to alcohol risk communication would promote health and wellbeing in older adults with long-term conditions and support better medication adherence.