GLASGOW COUNCIL on ALCOHOL Tackling the misuse of alcohol

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GLASGOW COUNCIL on ALCOHOLTackling the misuse of
alcohol

• COCAINE AND ALCOHOL
• THE HIDDEN MIXER
• 9TH OCTOBER 2006
• Alex Meikle

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GLASGOW COUNCIL on ALCOHOLTackling the misuse of
alcohol

• PREVALENCE LEVELS IN SCOTLAND
• No of people in Scotland with problematic drug
  misuse levels in Scotland 55,000
• No of people in Scotland estimated to be alcohol
  dependent 276,213 (Source Alcohol Concern 2003)

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GLASGOW COUNCIL on ALCOHOLTackling the misuse of
alcohol

• THE TIERS
• Tier 1 Services General public, prevention,
  education and awareness
• Tier 2 Services - People experiencing moderate
  to severe alcohol problems e.g. local councils on
  alcohol
• Tier 3 Services - People with severe alcohol
  problems requiring specialist help e.g. CAT
  Community Rehab
• Tier 4 Services People with acute alcohol
  problems requiring residential care or
  hospitalisation

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GLASGOW COUNCIL ON ALCOHOL

• GCA is composed of five key components, which
  are
• Prevention and education work
• The counselling services including the Alcohol
  Counselling Centre (ACC), Homelessness, Community
  Counselling and Young Peoples counselling
  service
• Training (both internally and externally)
• Groupwork i.e. the ACE Programme
• East End Community Alcohol Support Service

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WHAT GCA DOES . . . . . . . . THE MANTRA!!!

• ADDS VALUE TO ADDICTION SERVICES WITHIN GREATER
  GLASGOW BY
• Keep people at Tier 2, prevent them from
  relapsing to Tiers 3 or 4 and eventually move
  them to Tier 1
• Assess for, signpost and fast-track for people
  who need them into Tiers 3 and 4 services
• Provide throughcare service for people coming out
  of Tiers 3 and 4 services

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GLASGOW COUNCIL ON ALCOHOL

• Cocaine use in Scotland is the third highest in
  Europe (UN report July 2006)
• 1.4 of 15-64 year olds use this drug.
• Scottish Drugs Misuse Database (2006) reports 8
  of all presentations to addiction services in
  Scotland are using cocaine compared to 5 in
  2000/01
• Alcohol use has remained steady at 13 in 2004/05
  compared to 12 in 2000/01

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ALCOHOL AND COCAINE

• One study in US estimates that 75 of cocaine
  users use alcohol both independently and while
  using cocaine
• Harm from using both is greater than using either
  separately
• Treatment outcomes are different for simultaneous
  use
• Therefore, extremely important to identify
  simultaneous use

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ALCOHOL AND COCAINE

• Combined bio-chemical effects
• Alcohol leads to 30 increase in blood levels of
  cocaine if taken at the same time or just before
• Liver combines cocaine and alcohol to produce
  Cocaethylene which increases dopamine release and
  can lead to sudden cardiac death

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ALCOHOL AND COCAINE

• Combined psychiatric effects
• More euphoric and rewarding leading to an
  increased high
• Decrease in alcohol sedation or cognitive
  impairment
• Increase in interpersonal and physical violence
• Increase in sexual risk behaviours
• Increase in impulsive decision making and
  decrease impact on memory and learning

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ALCOHOL AND COCAINE

• Consequences
• The bio-chemical effects and the psychiatric
  effects combine with potentially disastrous
  consequences
• More Bangs for your bucks
• Less apparent effects of alcohol I can handle
  this better
• Two substances which in themselves lead to
  volatility in individuals have this factor
  significantly enhanced
• More impulsive behaviour
• Greater chance of heart failure and sudden death
• Treatment is more complicated as there are
  contra-effects i.e. withdrawl can be accompanied
  by intoxication

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ALCOHOL AND COCAINE

• Conventional Scottish Treatment Characteristics
  for Service Users
• Opiate/Injecting/Alcohol users
• Poor
• Unemployed
• Depressant users
• From Deprived backgrounds (Dep Cats 6-7)
• Strong association with physical and mental
  health issues as well as issues such as abuse
• Addiction as manifestation of deeper issues
  therefore treatment is necessarily holistic

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ALCOHOL AND COCAINE

• Treatment Characteristics for alcohol and cocaine
  users
• Polydrug users with no one substance in
  ascendancy
• Educated/Aspirational/Affluent
• Employed
• Stimulant user and risk taker with alcohol
  exacerbating the stimulant
• Classless from all backgrounds (Dep Cats 1-7)
• No necessary casual connection to other issues
• Addiction as hedonism related to lifestyle,
  culture, availability, leisure clashing with
  pressures of work and status

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CONSEQUENCES

• BUT COMBINATION OF ALCOHOL AND COCAINE CAN LEAD
  TO
• Spiral into unemployment
• Poverty
• Abuse
• Collapse of self-esteem
• Debt
• Criminal record
• Poor health
• Paranoia/anxiety/mental health issues

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ALCOHOL AND COCAINE

• Case Study 1
• 37 year old male, employed
• Consumes 32-35 units in one session
• Started taking cocaine to last the pace and keep
  awake
• Cocaine stopped him feeling depressed and
  worrying about money problems that had arisen
  over past two years
• Wished the weekend could last forever
• Got arrested best thing ever happened to him
• Rude awakening abstinent from alcohol and
  cocaine for last five months

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ALCOHOL AND COCAINE

• Case Study 2
• 32 year old male, employed, homeowner
• Strongly into image, appearance, suntan lounge
• Will spend between 300 -600 per weekend on
  cocaine and alcohol
• After work on Fridays all day drinking
  supplemented by cocaine taken in pubs and clubs
• Will consume 116 units of alcohol over 1 weekend
  (up to 52 units in one day) and 2-3 grams of
  cocaine
• Dont think youre drunk, think youre cool
• End up involved in fighting including broken
  teeth and black eyes, totally counter to cool
  image trying to project
• On Sundays will drink to unwind but end up
  using cocaine again
• Inevitably having problems with work Tired,
  depressed and paranoid
• Now being given alcohol counselling allied to
  motivational interviewing, stress management and
  anger management

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ALCOHOL AND COCAINE

• Case Study 3
• 20 year old male from deprived area, unemployed
• Drank heavily along with frequent use of cocaine
• Motivating factor in taking cocaine along with
  alcohol was boredom the combination of the two
  gave him a greater buzz
• Made him feel happy and upbeat about his life
• Began having seizures, which stopped immediately
  he ceased using cocaine
• Still drinking, but not as heavily
• Receiving counselling

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ALCOHOL AND COCAINE

• Conclusions
• These two substances in combination are
  potentially lethal within a relatively short
  period of time
• It is imperative that assessment and screening
  picks up dependency on both the conventional
  assessment of one primary drug and several
  subsidiary drugs is not appropriate here this is
  Co-dependency
• The client group will not normally have the
  typical characteristics associated currently with
  presentation at addiction services
• Use of these two substances would appear to be
  increasing
• They are used normally as part of a lifestyle and
  not as a response to deep underlying causes
• Other problems e.g. criminal record, abuse,
  unemployment follow on from the use of the
  substances and not the other way around
• Addiction workers have to be empowered and
  trained to deal with both substances
• Addiction services have a major role in secondary
  prevention work in preventing alcohol and cocaine
  use from causing the individual to spiral further
  into chaos and more resources are needed to do
  this
• Location and opening hours of services will have
  to be considered
• More research has to be carried out into the
  combined effects of both and to treat them as
  their joint use increases