British Drinking: Suitable case for treatment

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British Drinking Suitable case for
treatment

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• Rajani Iyengar

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Health warnings on cans to tackle binge
drinkingDrink laws will cause teen deaths, warn
liver doctors.
THE TIMES Licensi
ng act 2003
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UK is moderate consumer in terms of amount of
alcohol consumed compared to western european
countries.
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Drinking Culture

• Colder, northern countries (the UK, Germany,
  Austria) are beer-drinking cultures, while
  warmer, southern nations (Italy, France, Spain)
  drink wine
• They may drink more on the continent but they
  drink consistently
• In mediterranean culture wine is consumed on a
  regular basis as part of meals and family setting
• Now those habits are converging. The proportion
  of beer in our national alcohol intake has
  dropped by a quarter, while wine has more than
  doubled

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• Our European neighbours regard us as drunks. In
  fact the only people who don't think Britain has
  a drink problem are the British Alcohol
  Concern
• British social culture is built around drink.If
  you're going to meet people after work you meet
  them in a pub. If you're going out for a chat
  you'll go to a pub and in the pub there is a
  macho thing about how many drinks you've had.
  
  
• 
  The Guardian.
• Reason for binge drinking.

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Hazardous,At-Risk drinking
over 40 g of pure ethanol (5 units) per day for
men over 24 g of pure ethanol (3 units) per day
for women UNIT 8gm of ethanol, eg. half pint of
3.5 beer or lager 25ml pub measure of
spirits small (125 ml) glass of average
strength (12) wine contains 1.5U
Binge
Drinking
Men 8 units, women 6

IAS
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Is it a problem

• Alcohol causes nearly 1 in 10 of all ill-health
  and premature deaths in Europe
• WHOs Global Burden of Disease study risk factors
  for ill-health and premature deaths in Europe
• 1.smoking
• 2.raised blood pressure
• 3.alcohol
• Alcohol is more important than high cholesterol
• levels and overweight, three times more
  important than diabetes and five times more
  important than asthma.

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In UK

• More than 9m adults drink at levels that endanger
  their long-term health, and more than one in 25
  of us is alcohol-dependent
• The proportion of women drinking over the limit
  rose by 55 between 1984 to 1996
• 28,000 deaths a year are alcohol-related - but
  economically. Every year alcohol costs the NHS
  around 150m.

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CRIME

• A minimum of 1 in 5 people arrested by police
  test positive for alcohol.
• alcohol is a factor in
• o 60-70 of homicides
• o 75 of stabbings
• o 70 of beatings
• o 50 of fights and domestic assaults

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Screening for alcohol dependence and those at
risk

• AUDITAlcohol Use Disorders Identification Test
• IN GP setting,
• FASTFast Alcohol Screening Test or
  CAGE Plus two
• IN A E FAST or PAT
• IN Antenatal ClinicTWEAK T-ACE
• Biological tests
• MCV,GGT, CDT(carbohydrate deficient transferrin)
• breathalyser
• Blood Alcohol Concentration

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FAST
1.MEN How often do you have EIGHT or more drinks
on one occasion? WOMEN How often do you have
SIX. Never, less than monthly,monthly,weekly,dail
y,almost daily 2 .How often during the last year
have you been unable to remember what happened
the night before because you had been drinking 3
.How often during the last year have you failed
to do what was normally expected of you because
of drink? 4 .In the last year has a relative or
friend, or a doctor or other health worker been
concerned about your drinking or suggested you
cut down?
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Brief Intervention

• 5 mins to 45mins
• 10mins sufficient for oppurtunistic intervention
• evidenceeffective upto a year
• Motivational interviewing
• (a non-judgemental interviewing style which
  avoids confrontation, helps the individual weigh
  up the pros and cons of change, and enhances self
  efficacy)

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Management

• Community detoxification
• medications not reqired
• consumption is less than 15 units/day in men.10
  units/day in women.
• no recent withdrawal symptoms nor recent drinking
  to prevent withdrawal symptoms.
• the patient has no alcohol on breath test, and
• no withdrawal signs or symptoms

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Medications

• Benzodiazepines maximum of 7 days
• Choriazepoxide is preferred
• other medications used but only in specialist
  services
• CLOMETHIAZOLE
• ANTIEPILEPTIC MEDICATION
• ANTIPSYCHOTIC DRUGS
• TREATMENT OF THOSE AT RISK OF WERNICKE-KORSAKOV
  SYNDROME
• intramuscular Pabrinex
• those with diarrhoea, vomiting, physical illness,
  weight loss, poor diet

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• Signs of possible Wernicke-Korsakov syndrome in a
  patient undergoing detoxification
• confusion
• ataxia, especially truncal ataxia
• ophthalmoplegia
• nystagmus
• memory disturbance
• hypothermia and hypotension
• coma
• Needs urgent parenteral thiamine

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Follow up

• Psychiatric disorders specialists
• No support or environment of drinking12 step AA
• Monitoring low intensity,telephone brief
  consultation over a period of 1 to 3years
• Non-satutory organisations
• medications to prevent relapse
• AcamprosateGP should initiate if services not
  available in the area
• Supervised oral disulfiramrequires complete
  abstinence
• If depressive symptoms persist for more than two
  weeks following treatment for alcohol dependence,
  consideration should be given to using an SSRI

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Alternative therapy

• Review suggests transcedental meditation might be
  useful
• Acupuncture not helpful
• Insufficient evidence
• Organisations
• AL-ANON
• Alcohol Concern
• Alcohol Focus Scotland
• Down Your Drink
• National Alcohol Information Resource
• NHS Health Scotland

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T.A.P.S.Tayside Alcohol Problems Service

• Contactindividual,GP,social work
• GP,Patient Nurseagree about home
  detoxification. Breathalysed twice daily. One
  sensible adult at home.
• Relapse prevention clinicmotivational
  interviewing.
• Residential Unit at sunnyside hospital

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From Andy Dohertyandy_doherty_at_hotmail.com
Hey guys don't know if you had formatted
a Tutorial training record , or how you were
going to store it , but I've
I chose the drugs in the Dr's bag
one , if anyone's interested ... Andy PS Morag
, when's the next booze up ??