Prevalence of alcohol use disorders in Deaf psychiatric patients

Deaf people who use British Sign Language (BSL) as a first or preferred language are a recognised minority group in the UK. The body of evidence on Deaf people’s substance use is negligible. Clinicians working in a specialist psychiatric service for Deaf people, serving the south of England, surveyed the service’s caseload of Deaf psychiatric patients, using an alcohol screening instrument translated into British Sign language (The Alcohol Use Disorders Identification Test-AUDIT) to ascertain the prevalence of alcohol use disorders (AUD) amongst this group. Of 205 consecutive attendees n=144 took part; n=37 were excluded for not meeting criteria and n= 24 refused to take part. All subjects were given a brief written intervention for excessive alcohol use. Using an AUDIT cut off of 8, n=43 (29.9%) had an alcohol use disorders. Alcohol use disorders were commonest in males from white European backgrounds. There was no link with psychiatric diagnosis or age. N= 50 subjects who scored 6 or over on the AUDIT and n=52 who scored below 6 were interviewed with the Composite International Diagnostic Interview (CIDI). The AUDIT was found to be a reliable and sensitive instrument when crosschecked with the (CIDI) (92.2% correctly classified by AUDIT as having alcohol dependency; 4 false positives and 4 false negatives). Those reporting an AUD had a significantly worse EQ5D total than those who did not have an AUD. Of 18 subjects who had AUDIT scores of 8 or more, followed up in routine out patient appointments, 4 had significantly curtailed their alcohol intake, suggesting brief interventions for alcohol use may be useful in a Deaf population. Introduction Deafness (a severe to profound hearing loss) is common, occurring in around 1 per 1,000 of the population. There is a subgroup of about 75,000 people, mainly prelingually deaf, who are British Sign Language (BSL) users and who think of themselves as being part of the Deaf community and Deaf Culture (Department of Health, 2002a). The research population for this study comes from this community where being (D)eaf ‘refers more to membership of a particular linguistic and cultural grouping than it does to the physical condition of deafness’ (Brennan, 1992). The National Deaf Service provides a mental health service to Deaf people across the southern third of England. It provides assessment and treatments in BSL, taking into account cultural factors. In recent years there has been increasing research activity into the substance use patterns of different ethnic and cultural minorities (Westermeyer, 1995). Emphasis has been placed on the importance of socio-cultural factors impacting upon prevalence, incidence, pattern and course of alcohol use disorders. It seems probable that cultural factors can impact on Deaf people’s patterns of alcohol use. Deaf people, for example, share a history of discrimination against, and proscription of, their alcohol consumption in public bars and clubs (‘blanket bans’ on members of a particular groups) with other minorities, such as Gypsies (Morris, 2001) and the gay community (John and Patrick, 1999). Deaf people are also vulnerable to risk factors, such as poverty and social exclusion (Davidson, 2004), which have been, linked to an increased risk of substance use disorders in the general population (Home Office, 1998). There are also concerns those developmental factors for Deaf people may impact on their susceptibility to a range of disorders, including substance use disorders (Whitehouse et al, 1991). There has been some interest in alcohol use in the Deaf population. Two studies found no difference in rates of alcohol disorders between Deaf and hearing people. Isaacs, Buckley and Martin (1979) compared alcohol use in 39 white Deaf men with data from two comparable non-Deaf samples and found no significant differences between the Deaf and non-Deaf samples in patterns of alcohol consumption. Similarly, a survey of drug and alcohol use amongst New York City’s Deaf population suggested Deaf people experience similar drinking use patterns to the general population (Lipton and Goldstein, 1997). In Strathclyde a small survey of caseloads of social workers for Deaf people identified 39% of women and 54% of men as having an alcohol problem. These numbers were double the figures for general social work cases in the West of Scotland (Crawford, 1998). In the UK 236 Deaf adults were interviewed about a range of health related issues including alcohol use (Dye, 2000). 22% of Deaf men and 24% of Deaf women were found to drink above the recommended weekly intake of alcohol. Deaf women were almost twice as likely to drink dangerous levels of alcohol as hearing women, with 43% of those on higher incomes drinking above the recommended limits. Deaf men aged 18-24 drank the most with the average weekly intake being over 30 units. There have not been any studies of alcohol use in Deaf people with mental illness. Studies have consistently found high rates of alcohol use disorders in psychiatric patients (Reiger et al, 1990; Department of Health, 2002a).