Alcohol Problems and Treatment - An Overview

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Alcohol Problems and Treatment - An Overview

• Don Shenker
• Chief Executive

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Impact of alcohol misuse
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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

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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

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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!

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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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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)

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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)

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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

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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?

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Cycle of change (Prochaska DiClemente 1986)
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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

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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
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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)

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Thank You
dshenker_at_alcoholconcern.org.uk Tel. [phone]

• www.alcoholconcern.org.uk