Dutch doctors can contribute more to tackling the alcohol problem

26 February 2020

The Dutch Ministry of Health has stated that it wants the number of problem drinkers in 2040 to be half of the current estimate of 1.5 million. One of the key groups in achieving this goal will be the medical profession, but what are the prospects of Dutch doctors taking on this task, which they may fear is an unpopular one?

The Dutch Health Council, an independent scientific advisory body for government and parliament, published Dietary Guidelines in 2015. Based on the available scientific literature the advice of the Health Council concerning alcohol consumption is: "Don't drink alcohol or drink no more than one glass daily." This could be a basis for advice from doctors to their patients, however the Dutch Cardiology Association currently doesn’t yet support the Dietary Guideline so if there is a lack of agreement within the medical profession, the prospects of a clear message to patients are not good. The recent positive news is that they will reconsider their opinion.

On Saturday February 22, the TV-program Nieuwsuur spent half an hour on this theme. According to Nieuwsuur many doctors do not speak to their patients about alcohol consumption, because doctors sometimes lack knowledge about alcohol and they often regard alcohol consumption as a private matter and not something they should be discussing with patients.

"Alcohol is definitely a taboo," says Rob Bovens, alcohol researcher at Tilburg University. The reasons for the taboo are diverse. For example, treating an alcohol problem takes a lot of time for the doctor. "And often alcohol is not the main problem in the eyes of the patient" says Bovens. The view that alcohol consumption is considered “normal” also plays a role, according to Bovens. "If a patient drinks as much as the doctor, then it is difficult for the doctor to discuss it."

In addition to these barriers, there is disagreement among health organisations. For example, the Cardiac Rehabilitation Guideline of the Cardiology Association from 2011 still states that 'moderate use' (2 to 3 glasses per day!) can reduce risk. This is in sharp contrast to the Alcohol Guideline of the Health Council. "The Health Council is clear: don't drink," says addiction doctor Robert van de Graaf. "And that should be included in the Cardiac Rehabilitation Guideline. I think you shouldn't prescribe alcohol as a doctor, not even as a cardiologist."

In the Gastroenterology Department of the Jeroen Bosch Hospital in Den Bosch, over the past 6 months, all patients have been asked about their alcohol consumption. "Whatever the reason they have come here, all patients are asked about this," says doctor Henk Marijn de Jonge. According to Bovens, specialists in the hospital are in a good position to ask the question about alcohol. "Because the problem is more likely to be relevant for the patient, we are well placed to ask. I think the general practitioner also has authority, but he only has ten minutes for each appointment."

Jaap Seidell, professor of Nutrition and Health at VU University Amsterdam, advises drinkers to stick to the Health Council Guideline. He emphasizes that the idea that alcohol is beneficial for heart health is now challenged by recent research. However, the Dutch Cardiology Association said in a response that the Cardiac Rehabilitation Guideline is still their policy, but that it is being examined to try to achieve 'clarity in the advice of doctors'. Doctors' federation KNMG wants to arrive at a 'supported and substantiated' position on alcohol use in the long term.



Dutch Institute for Alcohol Policy STAP
P.O. Box 9769
3506 GT Utrecht
The Netherlands
T: +31 (0)30-6565041
F: +31 (0)30-6565043