Allergy or Addiction

There is a relatively new joke. "How can you tell if someone is vegan?
-You don't need to-. They will tell you."


When I qualified in 1982, if you were gay, you had to be discreet as it harmed your career. And more recently, on a flight, there was an announcement that some snacks were unavailable as someone on the plane had a nut allergy. Can you imagine if they said there were no alcoholic drinks?


On October 27, I went to a course run by Alcoholics Anonymous. Throughout the day there were a series of talks over an hour long. At the end the dentist I was sitting next to commented on how quiet the room had been and everyone had listened attentively. That doesn't apply to many of the CPD lectures I've attended over the years. When you have a talk by someone who generally has struggled and suffered, it makes you think how fortunate you are that you don't have the problems that many of these people seem to have inherited through no fault of their own. And similar to dementia and Cancers, the people who often suffer more are the immediate family supporting them.


We need to keep medical histories current, which used to be verbal, then written updates, and now online, before patients attend. I rarely discussed obesity, and more recently explained what HPV was, but discussing how to avoid it?? I did have some success with smoking cessation. My general line was, "Well, Tom, most patients I know who stop smoking do so after a stroke or heart attack-why wait?" As for drinking, most people, myself included, lie to you and themselves. 

My Dad lived with his dementia, and my mother cared for him for too long. I am just like my Dad. On refelection, some contributing factors to his disease were he went to the pub most nights, high cholestrol, smoking cigars, and in his day he was extremely good at heading a wet leather football. So I take some preventative measures. I don't smoke, and to his constant disapproval closed my eyes while attempting to head a football and take a statin with the understanding it roughly reduces my chance of a TIA or worse by around 1 in 250. Riding my bike probably helps a lot more. I also have a history of alcoholism among my relations,  as do many of you.


I have always enjoyed seeing friends in the pub. I ran peer review meetings For years, which we funded by paying the discussion lead with food and drink in the local pub. Menus in pubs often give the number of calories in the food and if it contains nuts. If you want to smoke, you have to go outside, as it's the law. I have yet to see a sign saying if you are allergic to alcohol.

Alcohol addiction is a huge problem, and the word alcoholic has a different stigma than if it was an allergy. Allergy promotes sympathy, but addiction is the opposite. You can be sure that some big pharmaceutical company will be trying to find a "cure" as long as you have to take a tablet for the rest of your paying life. Many of us have been drunk, and it's generally a choice. Being an alcoholic is not a choice. It's a progressive disease, and like oral cancer, early diagnosis and intervention improve outcomes. It is a mental health issue, which has a funding issue, and in Bristol, you need to be sober for three months to access mental health support. 


One thing that works better than anything in helping those with alcohol is AA. According to Cochrane, it is twice as effective as any other intervention. It requires no government funding, and while it's anonymous, it should not be invisible. It is a brilliant example of how a bottom-up organisation works, where many health top-down hierarchies fail. 


So how can we help? A nudge through our online medical histories? With technological advances, we should use them to signpost the public we see and those we don't, to access trustworthy resources to help. While there currently seems no funding available for dentistry, or mental health, there is for cancer and diabetes so any online medical form should have a section to access some discreet self-assessment and signpost support from where we have it. For quitting smoking, losing weight, having unsafe sex, reducing stress and risk of diabetes. Just a trusted link, embedded within these different sections that can be accessed by the user, for their benefit and potentially improve their habits through gamification that we may never see or record. It stays in their phone, with their history, and will be more accurate on what many tell us.

As a profession, we are trusted and have a large sphere of influence that we can exploit at almost zero cost. We can potentially improve the well-being of people we will never meet, which is the clear understanding of anyone who has completed the 12 steps in the AA fellowship group. We can utilise the mobile technology everyone carries 24/7. The AA website provides access to the next available support meeting for AA face-to-face nearby online through GPS. Why shouldn't we promote it within the alcohol section in the risk section?
We need to embrace other organisations on the periphery of health delivery,  as prevention is better than cure, and as we need to support ourselves. In many aspects of all health delivery we behave like a business cartel, rather than a health service. We should learn from each other.
We had regular peer review meetings as, like alcoholics, we understood and could help those with similar experiences and provide knowledgeable support. In general, informal peer review was the best of form of education and support I engaged in. The one on Mindfulness was unforgettable..

Today is my 63 birthday, but at ever-advancing years there comes the point when it is better to give than receive. I will be out with friends tonight and will have a few glasses of wine that I will enjoy, and tomorrow I will have a choice. 
Sometimes, we don't realise how lucky we are.
​


References.
​The one with the * is the best on addiction. It’s half way in. It’s funny, he’s an expert, he should be at the next BDA conference.

To find an AA meeting
https://www.alcoholics-anonymous.org.uk

To find an Al-anon meeting
https://al-anon.org


Youtube on AA
There are many, this is short. 
https://youtu.be/ZqORUQ5ahIs


Ted talk on health alternatives through experience
https://youtu.be/WQ2PFoHptK8


Prof David Nutt, one of many on alcohol
https://youtu.be/hAl1MlOZldU


*Alexei Sayle’s Imaginary Sandwich Bar. Satire helps.
https://www.bbc.co.uk/sounds/play/m001df6c

Details on Fellowships, and how to support them
https://www.visiblerecovery.uk/home

A new All Party Parliamentary Government unit to help addiction
https://www.12stepsappg.com

DENTAL SUPPORT

Dental Health support trust
https://www.dentistshealthsupporttrust.org

Confidential
https://www.confidental-helpline.org

Mental Dental Facebook Page
https://www.facebook.com/groups/1521725241212609/about/

There is no CPD with this. And there is no CPD for learning how to engage our patients digitally. HEE should provide it for ALL the dental team.