Hot Topic

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Hot Topic

• 4th March 2003
• NICK HALDANE

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?
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C2H5OH - Ethanol
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Alcohol Problems in Primary Care
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OBJECTIVES

• Prevalence of alcohol related problems
• The effects of alcohol
• Recognising problem drinking
• The tools of detection
• Managing problem drinking
• Managing alcohol dependence

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• I feel sorry for people who dont drink. They
  wake up in the morning and thats the best they
  are going to feel all day!
• (Frank Sinatra)

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Prevalence of alcohol related problems

• 0.4 Population alcohol dependent
• 2 Alcohol Problems
• 8 Heavy drinkers
• 7.5 consumer outlay
• Equates to 9 pints/adult per week
• Over 10 Billion per year

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Prevalence of alcohol related problems

• 9 of population had problem in previous year
• 1 in 5 drink above recommended levels
• 1/5 healthy men have abnormal LFTs
• Only 1 in 10 heavy drinkers known about

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The effects of alcohol
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The effects of alcohol
Beauty lies in the eye of the Beer holder
(Anon)
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The effects of alcohol

• Harmful effects
• Physical, Psychological and Social

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The effects of alcohol

• An Inn has one entrance and three exits
• to hospital, to asylum and to prison.
• (Croatian proverb)

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The effects of alcohol

• Harmful effects
• Physical, Psychological and Social
• Men drinking gt15u/wk higher mortality
• Drinking gt35u/wk doubles risk of CVA
• 30g/day increases HDL Triglycerides
• Decrease risk of CHD by 25

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Recognising problem drinking
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Recognising problem drinking
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Recognising problem drinking

• Recognition is difficult
• GPs well placed
• 2/3rds patients in 1 year / 90 in 5 years
• Long standing knowledge of patient and family
• Opportunity to observe change
• Chance to visit homes

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Recognising problem drinking

• Amount consumed in units
• Time of first drink
• Pattern of drinking
• Presence of withdrawal symptoms
• Use of specific questionnaires

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Recognising problem drinking

• Reminds me of my safari in Africa. Somebody
  forgot the corkscrew and for several days we had
  nothing to live on but food and water!
• (WC Fields)

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Barriers to detection - definitions

• No acceptable or universal definitions
• Lack of consistent advice
• HEC 1983 21u Men, 14u Women
• BMA/ College 1995
• 1/3rd higher in men
• 50 higher in women
• Expert advice contradictory

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Barriers to detection GPs attitudes

• GPs consume more than they should
• Lack knowledge, experience and skills
• Easier to avoid potential conflict
• BJGP March 2001 500 GPs/300 nurses
• Most Unable to determine content of 6 drinks
• lt50 determined 5 out 0f 6
• Only 50 knew safe limits
• gt40 recommended higher levels

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How well would we do?

• Pint of beer e.g. Tennants
• Bottle of wine
• Bottle of spirits
• Pub measure spirits
• Eng/Wales
• Scotland
• Pint of Strong beer
• e.g. Stella
• Bottle of Alco-pop

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How well would we do?

• Pint of beer e.g. Tennants
• Bottle of wine
• Bottle of spirits
• Pub measure spirits
• Eng/Wales
• Scotland
• Pint of Strong beer
• e.g. Stella
• Bottle of Alco-pop

• 2 units
• 8 units
• 30 units
• 25 ml, 1 unit
• 35 ml, 1.5 units
• 3 units
• 1.5 units

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Barriers to detection Patients attitudes

• Ignorance regarding safe levels
• Variety of vague effects not directly linked
• Psychological barriers resulting in denial
• Perception of a negative family doctor
• Underestimation of true consumption
• The unknown drinker may not present to the GP

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• It only takes one drink to get me drunk. The
  trouble is, I cant remember if its the
  thirteenth or fourteenth!
• (George Burns)

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The tools of detection

• Honesty
• Blood tests
• Opportunism
• Target driven
• CAGE (Mayfield 1974)
• MAST ( Pokorny 1972)
• AUDIT
• Five shot

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• A meal without wine is like a day without
  sunshine, except that on a day without sunshine
  you can still get drunk
• (Lee Entrekin)

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Managing problem drinking

• Population based strategies
• Brief interventions by GPs
• Support Family / Further referral
• Assisted withdrawal
• Prevention of relapse
• Self help groups
• Controlled drinking versus abstinence
• About 1/3 recover without intervention

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• An alcoholic is someone you do not like who
  drinks as much as you.
• (Dylan Thomas)

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Managing alcohol dependence

• Craving for alcohol which overrides normal
  social constraints on drinking
• Risk of withdrawal
• Community detoxification
• Support after withdrawal/ rehabilitation
• May need specialist mental health services

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• I am not a heavy drinker. I can sometimes go
  for hours without touching a drop.
• (Noel Coward)

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Any Questions?
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Summary

• Prevalence of alcohol related problems
• The effects of alcohol
• Recognising problem drinking
• The tools of detection
• Managing problem drinking
• Managing alcohol dependence

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• I would kill everyone in this room for a drop
  of sweet beer.
• (Homer Simpson)

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The End