Physical Therapists' Role in Reducing Alcohol Consumption

Physical Therapists' Role in Reducing Alcohol Consumption

By Dr. Sean M. Wells, PT, DPT, OCS, ATC/L, CSCS, CNPT, Cert-DN

The holidays are upon us and that typically translates to more alcoholic drinks. Data show alcohol sales tick up during these times often due to stress, social norms (New Years), and cultural reasons. Regardless of the reason, Doctors of Physical Therapy (DPTs) and rehabilitation professionals ought to be informed about the deleterious effects of alcohol: more importantly they ought to know one evidenced-based method to help their clients drink less in general.

Physical therapists that have taken our courses probably will ramble off the alcohol-associated health risks, but many DPTs don't know or don't educate their patients on these issues during PT. Some of these health risk include:

1. Liver Damage: Chronic alcohol consumption can lead to liver diseases such as fatty liver, alcoholic hepatitis, and cirrhosis. The liver plays a crucial role in metabolizing alcohol, and excessive drinking can overwhelm its capacity to process alcohol safely.

2. Cardiovascular Issues: While moderate alcohol consumption may have some cardiovascular benefits, excessive drinking is associated with an increased risk of high blood pressure, heart disease, and stroke.

3. Weakened Immune System: Heavy drinking can weaken the immune system, making the body more susceptible to infections and illnesses.

4. Mental Health Disorders:  Excessive and repeated alcohol consumption can lead to depression and anxiety disorders.

5. Cancer Risk: Chronic alcohol use is linked to an increased risk of several types of cancer, including liver, breast, colorectal, and esophageal cancer.

Many PTs recongize some of these more causal health disorders. However, alcohol has also been shown to exacerbate arthritis (OA), disrupt tendon healing (leading to tendinitis and tendinopathy), and worsen neurological recovery from stroke (CVA) and spinal cord injury (SCI). Many of these conditions are what DPTs are trying to help their clients recover from and alcohol, through inflammation and other mediators, worsens or slow the recovering from these conditions. 

The biggest health-related risk that has been popularized within research the last decades is the cancer risk associated with alcohol. For many years, physicians and healthcare providers knew the risk of liver and esophageal cancers with alcohol consumption. However, newer studies connect alcohol consumption with even common cancers like skin and breast cancer. While PTs may think we have little impact on cancer prevention, focusing on cancer risk reduction is the best way to go!

New  research  has emerged that one of the best methods for reducing patient alcohol consumption is to educate on the associated risk of cancer. In short, for every extra drink a patient consumes, they are incrementally increasing their odds of developing some form of cancer. This is a great fact to show our clients to encourage them to set limits, have days off of drinking, or to quit altogether.

There may be various forms and ways DPTs can get this information across, but I often start when I do my initial PT evaluation with a client. I ask clients not only about what medications they take but what supplements they are on, what substances they use (tobacco, marijuana, alcohol), and other lifestyle-related questions (e.g. physical activity, sleep). A simple screening of asking a person if they drink and how much/often can be important to deciding a successful vs an unsuccessful outcome. It should be noted that the clinician should often double the amount of alcohol a patient reports to you: they often under report or unknowingly consume more units of alcohol than stated. Usually when someone expressed frequent or excessive alcohol consumption at the evaluation, I will often connect their condition with the behavior (e.g. I can definitely help you with your chronic Achilles tendon problem but know that you can help first by cutting back on your booze). If this sinks in sufficiently I might add that cutting back on alcohol will help to further reduce their odds of developing a form of cancer.

If a PT suspects the person has an alcohol use disorder or alcoholism, the use of a  CAGE  assessment can be appropriate. Furthermore, recommending an alcohol reduction program like AA or referral back to the primary care provider can also be beneficial. Patterned alcohol use may be related to underlying mental health problems like depression, PTSD, and needs further workup by a licensed mental health counselor. Such conditions can also make recovery from chronic PT related issues even more challenging, so going to counseling can help with that as well.  In the end, there are several tools a PT can use to help clients cut back on their alcohol use: it appears that one that makes the biggest impact is just by talking about the risk of cancer and alcohol use. Have a Happy New Year and may 2024 bring you better health and less booze!

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