Alcohol Awareness Fraser Hoggan, Stephen Hounsom

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Alcohol Awareness Fraser Hoggan, Stephen
Hounsom Neil Strachan May 2007
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Aim of Session

• To raise awareness of the Health Social
  Implications of alcohol use and types of harm
  associated with alcohol

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Objectives

• Discuss cultural relationship with alcohol
• Explore the effects of alcohol
• Explore the harms caused by varying nature of
  alcohol use
• Identify harmful drinking patterns
• Increase awareness of sensible drinking messages

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Accepted part of our culture?

• Weve been brewing alcohol since before the
  Romans arrived
• Alcohol is deeply rooted in our culture and
  national identity
• Used to celebrate, commiserate ....
• Most people who drink alcohol do so without
  experiencing serious problems
• Binge drinking and drunkenness have become much
  more common over the last decade particularly
  among young people

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Accepted part of our culture?

• In 2006, Scottish Exec research showed that
• 1 in 5 Scots lie to avoid drinking
• 1 in 3 Scots drinking more than they want
• 1 in 2 young Scots have no idea how much they
  drink
• Evidence would suggest that Scots are more
  concerned about how they are perceived by their
  peers, than they are by the effects of excessive
  alcohol intake.

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Alcohol is it a problem?

• Health
• Alcohol related liver disease has increased 100
  in the last 10 years.
• Emergency admission rates for people with primary
  secondary diagnoses of acute intoxication and
  harmful use (associated with binge drinking)
  shows admission rates for Grampian are
  significantly higher than rest of Scotland.
• Other health harm can be related to risk-taking
  behaviours, for example unprotected sex,
  transmission of STI and unwanted pregnancy

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Alcohol is it a problem?

• Alcohol Related Deaths
• In 2004 Grampian had 107 alcohol related deaths
  (from 2052 reported in Scotland).
• There has been a 21 rise in such deaths in
  Scotland in only FIVE years.
• In 1990 alcohol related deaths accounted for 1 in
  100 deaths in Scotland. In less than 10 years
  this had risen to 1 in 40.
• It is accepted that such figures are often
  incomplete given miscoding of deaths or lack of
  recognition of alcohol as a contributing factor.

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Alcohol - Social harm

• In Scotland the economic cost of alcohol related
  harm was estimated at over 1.1 billion in
  2002/03
• Personal - impact on relationships,
  employability, confidence, finances
• Alcohol is a contributory factor in
• 40 of violent crimes
• 39 of deaths in fires
• 15 of drownings
• 17 of road traffic deaths

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Alcohol -short term physical effects

• Nausea and vomiting
• Slowed heart rate
• Coma
• Death
• Uncoordinated muscle movements
• Slurred speech
• Drowsy/sleepy
• Increased sexual arousal
• Decreased sexual performance
• Sensory impairment
• Headache
• Sweating

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Alcohol - long term physical effects

• Brain shrinkage
• Oesophageal varicies
• Liver damage hepatitis, cirrhosis
• Skin dehydration
• Impotence
• Reduced kidney function
• Cancers breast, throat, mouth, stomach, colon
• Pancreatitis

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Long term physical effects (continued)

• Fatty deposits on the heart
• Gastritis, stomach ulcers
• Inflammation of intestines, reduced ability to
  absorb nutrients
• Peripheral neuropathy
• Foetal Alcohol Syndrome (FAS)
• Alcohol Related Brain Damage (ARBD)
• Physical dependency
• Alcohol tolerance

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Alcohol - mental/emotional effects

• Short term
• Lower reasoning ability
• Exaggerated state of emotions
• False self confidence
• Long term
• Depression
• Anxiety
• Phobias
• Paranoia
• Psychological dependency
• Suicidal thoughts

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Harmful drinking patterns

• Chronic drinking drinking large amounts of
  alcohol regularly, often associated with alcohol
  dependence
• Binge drinking drinking excessive amounts of
  alcohol in a short period of time with the
  specific objective of getting drunk. Some may do
  this regularly or it may be occasional

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Alcohol dependence

• Drinking begins to take priority over other
  activities. Becomes a compulsion
• Tolerance develops, it takes more alcohol to
  produce drunkenness
• Withdrawal symptoms such as anxiety, tremor
  develop and are reduced by taking more alcohol.
• Often undetected for years may be masked by
  availability and acceptability
• May be a genetic component alcohol dependence
  clusters in some families, but its hard to be
  certain this is not learned behaviour

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Delirium tremens (DTs)

• Caused by cessation or reduction in alcohol
  intake
• Usually where prolonged heavy drinking has been a
  feature
• Effects include, fast heart rate, sweats, high
  blood pressure, marked tremor, vivid
  hallucinations and agitated behaviour
• Can lead to seizures
• Can be fatal if untreated

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Korsakoffs syndrome

• Caused by lack of Vitamin B1 (Thiamine) which
  affects brain nervous system
• Alcohol use is often cause of this deficiency
  poor diet in heavy drinkers over longer term.
  Alcohol also affects how well body absorbs key
  vitamins
• Brain damage can occur if untreated (with Vit B1)
• Results in severe short term memory loss,
  difficulty acquiring new skills, lack of insight
  into condition, talkative and repetitive
  behaviour
• Younger cases now being reported

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How can people get help?

• Prescribing Antabuse, Acamprosate, Naltrexone
• Talking based treatments Cognitive Behavioural
  Therapy (CBT), Motivational Interviewing,
  Counselling
• Range of voluntary and statutory services

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Confusion about units....

• Advice has been conflicting
• Awareness of units concept
• Interest in units concept
• In 2006 a Student Survey in Edinburgh concluded
  that only 2 of females and 4 of males
  understood the unit concept.
• 9 out of 10 did not use units to calculate
  alcohol intake

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Sensible Drinking Guidelines

• Women - up to 2-3 units of alcohol a day, not
  exceeding a total of 14 units per week with at
  least 2 alcohol free days per week
• Men - up to 3-4 units of alcohol a day, not
  exceeding a total of 21 units per week with at
  least 2 alcohol free days per week
• Young people theres no safe limit for young
  people
• Takes 1 hour for the body to process 1 unit of
  Alcohol

The emphasis is now on daily units to discourage
heavy binge or weekend drinking
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How much is too much?

• Large glass wine (250 ml) at 13 ABV 3 units
• Average glass wine (175 ml) at 13 ABV 2.3
  units
• Lager/beer (440 ml can) at 3.5 ABV 1.5 units
• Lager/beer (440 ml can) at 5 ABV 2.2 units
• Pint of strong lager (5 ABV) 2.8 units
• 25 ml measure of spirit (e.g. gin, vodka etc.)
  1 unit
• 330ml bottle of beer/lager/alcopop at 5 ABV
  1.7 units

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Alcohol pregnancy - new recommendations from
CMO

• Avoid alcohol if pregnant or trying to conceive

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Foetal Alcohol Syndrome (FAS) Foetal Alcohol
Spectrum Disorder (FASD)

• FAS
• Characteristic minor abnormalities of the face
• Growth restriction pre post natal
• Neurodevelopmental problems
• Maternal alcohol consumption has been high
• FASD
• Studies have shown that elements may be present
  where maternal alcohol consumption has been more
  moderate
• 1 of 3 FAS features may be present, thought to
  most commonly be neurodevelopmental problems

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ABV Unit labelling
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Responsible drinking tips

• Remember - It is fine not to drink alcohol.
  5-10 of the population choose not to drink
  alcohol
• Drink water or soft drinks between alcoholic
  drinks
• Eat before or during drinking
• Drink tall mixers avoid neat spirits
• Drink purer drinks. Clearer drinks have less
  congeners
• Pace yourself, be wary of getting involved in
  rounds
• Keep an eye on the strength and volumes of drinks
• Home measures are often larger than pub measures
• Drink plenty of water before going to bed
• Plan your night out, think about how you will get
  home etc.
• Look after your friends, if their in a bad way
  help them out

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Source of further information

• www.infoscotland.com/alcohol

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Thank You

• fraser.hoggan_at_nhs.net
• neil.strachan_at_nhs.net
• Stephen.hounsom_at_moray.gov.uk

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