Title: British Drinking: Suitable case for treatment
1British Drinking Suitable case for
treatment
- This presentation will probably involve audience
discussion, which will create action items. Use
PowerPoint to keep track of these action items
during your presentation - In Slide Show, click on the right mouse button
- Select Meeting Minder
- Select the Action Items tab
- Type in action items as they come up
- Click OK to dismiss this box
- This will automatically create an Action Item
slide at the end of your presentation with your
points entered.
2Health warnings on cans to tackle binge
drinkingDrink laws will cause teen deaths, warn
liver doctors.
THE TIMES Licensi
ng act 2003
3UK is moderate consumer in terms of amount of
alcohol consumed compared to western european
countries.
4Drinking 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
5 - 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.
6Hazardous,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
7(No Transcript)
8(No Transcript)
9Is 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.
10In 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.
11CRIME
- 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
12Screening 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
13 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?
14Brief 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)
15Management
- 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
16Medications
- 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
17- 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
18Follow 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
19Alternative 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
20T.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
21From 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 ??