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Episode 7

Alcohol and other drugs

Show notes

Welcome to Generally Speaking, the conversation for all GPs.

Join GPs Dr Gill Singleton and Dr Billy Stoupas as they discuss some of the most pressing topics and issues surrounding the operations of a GP.

This episode, Dr Stoupas and Dr Singleton tackle the issue of alcohol and drugs in our community. They are joined by Melbourne GP, Dr Paul Grinzi who is a lead medical educator at the RACGP.

03 June 2020 - 03:50 PM | 14 min 45 sec

(00:24) Dr Singleton and Dr Stoupas will discuss commonly used and misused substances like alcohol, along with prescription drugs, as well as illicit drugs including ice (methamphetamines). They will be joined by special guest, Dr Paul Grinzi, a Melbourne GP and medical educator with a particular interest in alcohol and other drug addiction. 

(01:24) Dr Stoupas and Dr Singleton touch on refugee health in relation to alcohol and other drug abuse. Plus they reflect on mental health and socio-economic status as risk factors regarding these issues. Statistically, it’s been cited that one in four Australians have misused alcohol, and a staggering 1.3 million Australians have used methamphetamines at some point in time. While alcohol use and abuse is prevalent and widely accepted, it’s impact is significant. Also significant is the issue of prescription drugs in our society, and Dr Singleton talks about the concern over prescribing opiates.

Introduction of Dr Paul Grinzi

(03:31) Dr Singleton inquires about Dr Grinzi’s story and interest in the field.

He explains that while originally apprehensive about it, when he first started his general practice registrar training, he had the opportunity to spend a six-month term dealing with alcohol and drug cases. During that term, he realised that he garnered insights which ultimately aided his current practice. Namely chronic disease management, which entails personal care, looking after families, looking after people within their communities. He also found it rewarding that the gains he aided in many of these cases were quite substantial and that he felt he was actually changing their lives.

(05:30) Dr Singleton says that she felt the same with regard to drug and alcohol cases and was glad to hear that she wasn't on her own.

Dr Singleton mentions the recently available educational resource for GPs, the Alcohol and Other Drugs GP Education Program, as a segue to asking Dr Grinzi about the prevalence of different substance use in the community.

Dr Grinzi explains that alcohol is certainly number one in impact with multiple effects across our physiology. It’s responsible for substantial harm and costs our community in terms of both the number of patients and also the subsequent effects in industry and family, etc. In the spectrum of illicit substances, cannabis is number one by far, in terms of use but not necessarily in terms of harm. And while opioids, both illicit and prescribed cause more harm than cannabis, it is alcohol that trumps all drugs in relation to the actual harm done to our community. Over the last number of years, there has been emphasis both in the media and within professional circles around the use of methamphetamines, but compared to other drugs, it is actually a less frequently used substance, particularly again, compared to alcohol. Unfortunately, it's the culture around alcohol use, its ease of availability and the fact that as a substance, it adversely affects almost every system in the body.

(07:10) Dr Stoupas asks about the use and abuse of prescription drugs.

Dr Grinzi explains that the ones that are causing harm are largely in the opioid and benzodiazepine classes. While the opioids have more inherent harms than the benzodiazepine, the combination of the two is quite lethal and has contributed to many unintended fatal overdoses in Australia. In fact, more than the road toll. Dr Grinzi’s experience, at many international conferences on addiction and through many conversations with addiction specialists around the world, is that patients don’t actually decide to become addicted to a drug. It is never a choice. So, his approach and intention is to try to destigmatise these medications and not to judge the people who take them. He thinks that if we treated patients a bit more kindly, then the community, the politicians and the media, might take on those beliefs as well.

(08:42) Dr Singleton enquires about the concurrence of mental health issues and substance use.

Dr Grinzi notes that assessing patients suffering from drug and alcohol related issues and assisting them towards recovery takes a fair bit of time and doesn't happen within a single consultation. It may take many consultations to develop rapport, trust and to encourage the revelation of previous personal trauma, interpersonal or family conflicts etc. While time consuming, this approach gives better context around how a patient presents and why they may have arrived at this particular point in their lives. That in turn provides more robust insights for crafting therapy and management plans specific to the patient rather than just a one-size-fits-all approach. 

(10:05) Dr Stoupas asks how and where someone might go to upskill in this field.

Dr Grinzi is happy to report that a national education program for all GP members of the college is rolling out in 2020 and on to 2021. It’s a three-tiered training program. The first is an online module, Essential Skills Training, which is open to all GPs. The second, Treatment Skills Training is closely targeted to areas where Federal Government funding is focused.

Primarily for GPs working with higher risk populations, gender diverse populations, people experiencing homelessness, Aboriginals and Torres Strait Islander communities, and often those in remote areas, this tier can be government-funded for particular GPs and can be undertaken in a clinic, a workshop or online via an interactive case-based videoconferencing community over a 10-week syllabus. 

The third and final tier, Advanced Skills Training, targets GPs who are already doing a lot of this work so it looks to upskill even further. Dr Grinzi points to the availability of these courses to all GPs through the RACGP website at www.racgp.org.au/aod

(13:10) Dr Singleton offers her thanks to Dr Grinzi for his insights and time.

She wraps up with some of her key outtakes, such as the importance of taking enough consultation time with affected patients and reflecting on what other mental health or traumatic issues may be present for them.

  • The Alcohol and Other Drugs GP Education Program is a new resource for GPs dealing with patients experiencing alcohol and other drug-related issues, and is a three-tier online and clinically based program. For more information visit www.racgp.org.au/aod
  • Assessing patients experiencing alcohol and other drug-related issues and assisting them towards recovery takes a fair bit of time and doesn’t happen within a single consultation. It may take many consultations to develop rapport, trust and to encourage the revelation of previous personal trauma, interpersonal or family conflicts.

‘I’ve gone to international conferences on addiction and spoken to addiction specialists around the world. I’ve never had anyone, not one, say they’ve met a patient who decided to become addicted to something. So it’s a consequence of use, consequential circumstances, it’s never a choice.’

‘One of the reasons alcohol is up front is, unfortunately, the culture around alcohol use. The availability of alcohol use is enormous. And as a substance, it affects pretty much every system in the body.’
– Dr Paul Grinzi

Generally Speaking is an RACGP podcast, sponsored by CommBank and hosted by GPs.

Resources referred to in the podcast and on the webpage are not necessarily endorsed by RACGP and views of the presenters are their own.

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