Let’s knock out alcohol waitlists

We need to fix alcohol waitlists

Why the healthcare system is suffering from a hangover

Right now, hundreds of thousands of people — hell, millions internationally — are seeking support to change their relationships with alcohol. But as many as 70 per cent of them are not receiving it. These people fall into two groups. First, those who do not meet the medical criteria for having an “alcohol problem” (more on that wording later), who are stuck in a healthcare grey area. And second, a group who do meet the criteria to receive medical treatment for their alcohol use, but are marooned on waitlists or priced out of help.

A bigger issue than we realise

The thing is, most of us drink alcohol. Second to only caffeine in terms of global consumption levels, alcohol is a consistent feature in the average person’s life. When we’re talking about an issue that affects this many people, there is rarely a simple fix. But amidst a jumble of medical bureaucracy and inadequate, yet entrenched, healthcare schemas, there lies the problem: people who need help are not getting it. And it’s not long before this problem bites back, hard.

We know that, in Australia alone, on top of the people who are already receiving help for alcohol and drug related health issues, it is estimated that there could be as many as 500,000 people seeking help and not receiving it. Every year. The entire population is only a little over 24 million.

Falling short of a “problem”

So imagine for a minute that I really want to drink less. Let’s say that I have felt this way for a while now, but haven’t felt ready to talk about it.

Note that it is remarkably unlikely my doctor herself will bring up my drinking. Recent research indicates that more than 80 per cent of adults in the US report never having a conversation about alcohol with their doctor.

So finally, after months, even years, of mustering up the courage to ask for help, I say something to my GP.

Hmm, my doctor murmurs. You are in great physical condition, have a supportive family and a job you enjoy. You’re doing well …

“Have you tried moderation?”

Belle Robertson describes the exasperation of this question in her open letter to doctors: “If we are asking for help, we have tried moderation,” she says.

So where does that leave me? If I am dissatisfied in my relationship with alcohol and feel that I need help, then believe me, I need help. That is why I am, you know, asking.

Sure, help will come. But too late.

This isn’t about my doctor, or about Belle’s doctor; they’re both doing their jobs. This is about the system. This ‘after the fact’ care, which arrives too little too late, is a persistent issue across the domain of medicine. It’s a symptom of a wider, more entrenched systemic ailment that the Western medical system is currently suffering: no one receives help until it’s really bad.

Some have made the interesting observation that our healthcare system is, in fact, sickcare. Ivan Illich begins his thesis on the Limits of Medicine, by claiming that “the medical establishment is a major threat to health.” This, with regard to alcohol and drug use, certainly seems to be part of the problem. Working in the space of alcohol at Australian non-profit, Hello Sunday Morning, I have heard countless examples of people who, yes, have received care for their drinking habits — exactly as medicine promises, but only when, as per the established thresholds and criteria, they have a clearly discernible problem.

And I cringe at using that word: problem. Because within the context of alcohol use, it’s arbitrary. Changing your drinking behaviour isn’t about problems. It’s about opportunities and experiences gained, it’s about pursuing greater well-being as you define it for yourself. It is about changing your drinking habits when you feel ready–not when the medical handbook says you can. But this paradigm conflicts with our symptom-based health system.

What makes this more upsetting is that shifting the system in favour of prevention, rather than treatment, is totally viable. In fact, it may even be financially preferable. But unfortunately, preventative health care is an investment for which, at this stage, the return cannot be guaranteed.

The waiting game

In fact, the issue of medicalisation and the lack of preventative support is only part of the problem. Plenty of people are actually meeting these thresholds for “problem” alcohol use. And most of them? They’re sitting on waitlists with no support.

We know that, in Australia alone, on top of the people who are already receiving help for alcohol and drug related health issues, it is estimated that there could be as many as 500,000 people seeking help and not receiving it. Every year. The entire population is only a little over 24 million.

Worse still are the poor predicted outcomes for people who are either on waitlists or experience other barriers to treatment and support. The longer you have to wait, the less likely the assistance that you eventually receive is actually going to help.

The longer you have to wait, the less likely the assistance that you eventually receive is actually going to help.

So what we know is this: there are hundreds of thousands of people out there who are ready to change their relationships with alcohol. And only the smallest fraction of them are actually getting support.

Visiting again, my imaginary doctor and I, sitting in her effervescently lit clinical office, me feeling deflated at my attempts to reach out. This is exhausting.

But, you see, what can my doctor do besides tell me to moderate my drinking? I do not fit the category of people appropriate for the support she has available. She doesn’t realistically have many choices. This is the crux of the problem we’re facing.

And this problem is what conversations would always turn to at Hello Sunday Morning. Eventually, water cooler chats grew into key points of concern for the organisation, leading us to one of our proposed solutions: Daybreak. Daybreak is an app. It’s easy to use and has a number of useful features to provide a place for those people who don’t fit the “people to treat” mould as per the medical system. Daybreak is for those who are stuck on treatment waitlists. For those who are ready to change their relationship with alcohol and change their drinking habits but don’t know where to turn for extra support. But we hope this is just the beginning of the movement towards a better drinking culture.

Alcohol itself is associated with about 5.9 per cent of global morbidity and mortality each year. That’s significant. And this doesn’t take into account the harm inflicted on other people, or the overall burden: social; financial and health; that alcohol imposes on society.

Far from the glamorous images that the alcohol industry consistently serves us, this is really what alcohol stands for. A whole host of chronic diseases and a general lack of well-being.

Yet despite all of this, alcohol is not the villain. We would never propose that the world stop drinking. Alcohol (probably) has its place. But somewhere along the line, humans began to engage in, say, a polite disagreement with booze. We realised that, sometimes, it might not be the enormously beautiful, sublime feature of human folklore that we are taught it is. We should be enjoying alcohol, not crumbling under its reign. It’s time to take back the considerable amount of cultural space that alcohol occupies.

If we don’t address these issues, the healthcare system is about to suffer its biggest hangover headache to date.

Hello Sunday Morning is a movement towards a better drinking culture. Our vision is a world where drinking is an individual choice, not a cultural expectation. How do you feel about your relationship with alcohol?
Download Daybreak, for iOS or Android to change your drinking habits today. Alternatively, join our online community of over 100,000 like-minded individuals.