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Alcohol Problems and Treatment - An Overview

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Title: Alcohol Problems and Treatment - An Overview


1
Alcohol Problems and Treatment - An Overview
  • Don Shenker
  • Chief Executive

2
Impact of alcohol misuse
3
Impact of alcohol dependency on health services
  • 1 in 4 acute male admissions are alcohol related
  • In 11 of cases, alcohol is the main cause of
    mens high blood pressure
  • Alcohol is a factor in 48 of all violent crime
  • At peak times 7 out of 10 people attending AE
    have alcohol related problems
  • Alcohol misuse costs the NHS 2.7 billion a year
    and totals 25Bn pa

4
Daily guidelines for sensible drinking adults
  • Recommended sensible drinking
  • 2-3 units or less for women
  • 3-4 units or less for men
  • CMO recommends no alcohol for under 15s
  • Department of Health

5
Units of alcohol
  • 1 unit half pint beer (3.5 alcohol)
  • 1 unit single spirits (25ml _at_ 40 alcohol)
  • 1 unit 1 glass wine (125 ml _at_ 8 alcohol)
  • But these are now quite rare!

6
Government Categories
  • Lower risk drinkers (who are at a low risk of
    alcohol-related illness) are defined as
  • Men who dont regularly drink more than 3 to 4
    units a day
  • Women who dont regularly drink more than 2 to 3
    units a day
  • Increasing risk drinkers (who are at an
    increasing risk of alcohol-related illness) are
    defined as
  • Men who regularly drink more than 3 to 4 units a
    day but less than the higher risk levels
  • Women who regularly drink more than 2 to 3 units
    a day but less than the higher risk levels.
  • Higher risk drinkers (who have high risk of
    alcohol-related illness) are defined as
  • Men who regularly drink more than 8 units a day
    or more than 50 units of alcohol per week
  • Women who regularly drink more than 6 units a day
    or more than 35 units of alcohol per week
  •  

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8
Related health conditions
  • Chronic Disorders
  • Gastrointestinal
  • Cardiovascular
  • Neuropsychiatric conditions
  • Cancers
  • Admissions34,000-91,000
  • Acute Disorders
  • Acute Toxic Effects
  • Accidents and assaults
  • Self-inflicted injuries
  • Admissions40,000-60,000
  • Sources DoH (1995), Gutjahr et al (2001),
    Britton and McPherson (2001)

9
Alcohol related crime
  • Estimated 1.2m incidents of alcohol related
    violence
  • 80,000 arrests for drunk and disorderly
  • 19,000 sexual assaults related to alcohol
  • 85,000 cases of drink driving
  • 360,000 victims of alcohol related domestic
    violence Source Strategy Unit Interim
    Analysis (2003)

10
Alcohol and the family
  • Relationship breakdown
  • Domestic violence and aggression
  • Health impacts
  • Poor parenting
  • Unsafe sex
  • Marriages twice as likely to end in divorce
  • 1/3 of divorce petitions (W.H.O.)
  • About 2m children affected by parental alcohol
    problem
  • Between 30-60 child protection cases

11
FAST
  • 1. MEN How often do you have EIGHT or more
    drinks on one occasion?
  • WOMEN How often do you have SIX or more drinks
    on one occasion?
  • 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 drinking?
  • 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?

12
Cycle of change (Prochaska DiClemente 1986)
13
Elements of brief adviceFRAMES
  • Feedback about risks of substance use
  • Responsibility placed on client to change
  • Advice to cut down / abstain etc.
  • Menu of options and choices
  • Empathic approach
  • Self-efficacy using a non-confrontational
    counselling style which encourages reinforces
    clients strengths

14
Stepped Care Approach
Aimed at individuals with a high level of
presenting need. Inpatient detox and
stabilisation, residential rehab or
residential crisis intervention
Tier 4 ab
Solely for misusers in structured programmes of
care
Treatment services
Tier 3
Care planned counselling
Provide accessible alcohol specialist services
for a wide range of alcohol misusers
Self-help groups
Assertive Outreach
Tier 2
Drop in services
Outreach
Specific advice information services
Police/CSO
Services that work with a wide range of clients
Tier 1
Housing
AE/Walk in Centre/Minor injuries
Primary Care
15
Types of treatment
  • Advice and information (Tier 2)
  • Self-help groups (Tier 2)
  • Care planning counselling (Tier 3)
  • Structured day programmes (Tier 3)
  • Community detoxification (Tier 3)
  • Inpatient treatment (Tier 4)
  • Residential rehabilitation services (Tier 4)

16
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17
Thank You
dshenker_at_alcoholconcern.org.uk Tel. 020 7264 0510
  • www.alcoholconcern.org.uk
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