most deprived area - tower hamlets ccg hamlets alcohol nis.pdfby drinking 12 rums and coke a week...
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THCAT
3rd most deprived area Registered population 240,000 Young population Growth of 30,000 in next 5 years Highest increase will be in working age 34% Bangladeshi (much higher in under
20s) Recent data shows 3.9% Eastern European 2.8% Somali
Hospital Episode Statistics for 2007/08 report that
399 males and 128 females were admitted for
conditions specifically caused by alcohol use
While the number of alcohol related admissions to
hospital in Tower Hamlets remain fewer than
those observed for either City and Hackney or
Newham, numbers nonetheless continue to
steadily rise
NI39: alcohol related admissions to hospital –
2007/08 -2589 alcohol related hospital admissions.
Ready availability of alcohol
Bangladeshi and Somali young people consuming alcohol in contrast to their abstinent parents
Approximately 50% abstain from alcohol consumption
Lower overall consumption but relatively high levels of associated health and social harms
Higher rates of alcohol abuse and dependency among A10 migrants coupled with issues prohibiting access to statutory services and a reliance on emergency services
Region
Hospital
admission for
alcohol-
related harm.
All persons
DSR per
100,000
population
Lower
95% CI
Upper
95% CI
Number of hospital
admissions due to
alcohol related harm
Tower
Hamlets 1670.1 1613 1727 2588.52
City and
Hackney 1773.32 1721 1825 3182.04
Newham 1917.57 1867 1969 3805.64
London 1319.62 1311 1328 96194.21
England 1384.04 1381 1387 799119.73
From Healthy
Lifestyles Survey
(2009)
Percentage of
potential
hazardous and
harmful drinkers
3rd most deprived area
Highest child poverty
High unemployment
Low education outcomes
Poor housing quality
High crime rate
Social isolation
High risk factors
- Smoking
- Lower physical activity
- Poorer diet
PEER PRESSURE
DEPRESSION
BEREAVMENT
UNEMPLOYMENT
SOCIALISING
STRESS
SOCIAL ISOLATION
SERIOUS MENTAL ILLNESS (Co-morbidity)
A UK 'unit' is 10ml of pure alcohol.
Why this amount?
It's all to do with how our bodies deal with alcohol. On average, healthy adult bodies can break down 10ml of alcohol in an hour. So, if you drink 10ml of alcohol, 60 minutes later there shouldn't be any left in your bloodstream.
Where does the alcohol go?
The liver breaks down most of it, though a small amount escapes through the skin, on the breath and in our urine.
What does 'ABV' mean?
ABV stands for Alcohol By Volume. All pre-packaged alcoholic drinks must state how strong they are. Strength is shown as a percentage, with the letters ABV after the number. For example, most popular wines today are around 13% ABV, beers around 3.8% ABV.
However ‘super strength’ beers can be as much as 9.0 ABV. And they are becoming the norm with many drinkers
Some wines are 9% ABV but the most popular ones average around 13%.
To find out how many units are in a drink, you need to know its volume in millilitres its %ABV strength Most packaged drinks state their volume in millilitres (ml).
However, bottles of spirits and wine often state their volume in centilitres (cl). To get from centilitres to millilitres, simply stick another zero on the end. So, 75cl = 750ml.
To find out how many units of alcohol are in a drink: Multiply the volume (in millilitres) by %ABV then divide
the result by 1000. Units = (volume (ml) x % ABV) /1000
Government guidelines on alcohol units –
The Government's guidelines say that a male should not regularly drink more than 3-4 alcohol units a day and a female should not regularly exceed 2-3 units a day.
An excellent guide to this can be found at –
http://www.drinkaware.co.uk/tipsandtools/drinkdiary.
Alcohol and liver disease
Alcohol induced liver disease accounts for over half of all the liver disease in the UK.
Source: British Liver Trust
Alcohol and weight gain
By drinking 12 rums and coke a week you will consume 2880 empty calories.
Alcohol and cancer
After smoking, drinking alcohol is the biggest risk factor for cancers of the mouth and throat.
The risk of breast cancer in women increases by about 7% for each additional drink taken every day.
Source: Cancer Research UK
Stage 1 – A social lubricant?
After one or two drinks (1-3 units), we're more talkative and our heart rate speeds up a little, giving us an 'up' feeling. This is the effect that people refer to when they say alcohol makes them feel more sociable. The 'warm feeling', or flushes, is caused by alcohol in the blood making small blood vessels in the skin expand, allowing more blood to flow closer to the surface and lowering blood pressure at the same time.
Stage 2 – Giddy up!
After a couple more drinks (4-6 units) we feel light
headed and our co-ordination and reaction times
are impaired. Our ability to make decisions is also
slowed down. All of these effects are cased by
alcohol acting on nerve cells all around the body
and making them work more slowly. Driving will
be illegal (and dangerous) and operating
machinery a bad idea.
Stage 3 – I'm perfickly shober!
Another few drinks (7-9 units) and most people
will show definite outward signs of alcohol's
effects. Reaction times are much slower, vision
becomes blurry and speech is slurred. Drinking
more than eight units at a time seriously overloads
the liver. If we take care of ourselves in the days to
come, it should repair itself but for tomorrow a
hangover is pretty much guaranteed.
Stage 4 – Nobody's friend . . .
Drinking more than 10 units has most people staggering about the place. Accidents are commonplace – as are fights caused by bumping into people who're easily upset by such things. This amount of alcohol will be affecting cells all over the body. In an effort to rid itself of the poison, the body tries to pass the alcohol out mixed with water in our urine. This is why alcohol makes us go to the loo a lot and is the cause of the dehydration that gives us morning-after headaches. Alcohol also attacks the gut, causing stomach upsets, heartburn, sickness and diarrhoea.
Drinking more than 30 units (that's about twelve pints of strong lager) is enough to knock most people out. From there, it's a short step to heart failure and breathing slowing to a stop. Even when people are already unconscious, alcohol in the stomach can continue to be absorbed and can reach lethal levels. People can also be sick and suffocate on their vomit.
For these reasons, it's crucial never to leave very drunk people on their own.
CULTURAL SENSITIVITY
NON-JUDGEMENTALISM
ROLLING WITH RESISTANCE
REALISTIC GOAL SETTING
Provision of widespread screening for alcohol consumption (new patients and at risk groups)
Recording of alcohol consumption in the borough, 36 GP practices!
Assessment and treatment (brief intervention and/or referral on to appropriate treatment)
Wide range of GP practice staff trained and skilled to support people to change behaviour
Brief intervention in primary care setting
Increase recording of alcohol Identify levels of harmful/hazardous
drinking Provide community detoxification with
appropriate support Skilled workforce in delivering range of
health change interventions, widely applicable to other areas of health intervention
Support general practice in working with other providers, specifically Community Alcohol Service
Level A screening and brief advice, units consumed, Audit C, provided by trained practice staff
Level C (supported community detoxification) partnership with local alcohol provider and GP
Clients can be referred by any agency (with the
clients consent), clients can also self refer
Client is assessed by the practice nurse for
suitability
A request is made for the GP to arrange the clients
bloods and Liver Function (LFT’s)
If suitability is met the nurse will contact the GP
and request the detoxification medication
Detoxification can be of 5 or 8 day duration
depending on the level of weekly unit consumption
Physical Dependency on Alcohol
Physical dependency = people drinking between
70-250 units per week
Age range 18-65
A supportive person (partner, family member,
friend or neighbour) who can be available during
detox period. And a suitable home environment.
If on assessment, the client does not meet the
criteria – refer for in-patient detoxification
A desire or sense of compulsion to drink
Needing a drink first thing to offset withdrawals (Eye opener)
Difficulty controlling use or unsuccessful efforts to cut down or control alcohol
use
physiological withdrawal when attempts at reduction or abstinence are made
evidence of tolerance, such that increased amounts of alcohol is required to
achieve intoxification or desired affect
Salience of alcohol use. A great deal of time is spent in activities necessary to
obtain alcohol, drink alcohol, or recover from the effects. Alternative pleasures
are neglected.
Continued drinking in the face of persistent or recurring social,
Psychological or physical harm.
Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-
Ar)
NAUSEA AND VOMITING
TREMOR
PAROXYSMAL SWEATS
ANXIETY
AGITATION
TACTILE DISTURBANCES
AUDITORY DISTURBANCES
VISUAL DISTURBANCES
HEADACHE, FULLNESS IN HEAD
ORIENTATION AND CLOUDING OF SENSORIUM
People who have severe physical problems
Those with history of fits/epilepsy and Delirium Tremens
Heavy poly substance users
Those developing/with signs of Wernicke-Korsakov
symptoms
People who have a history of suicide attempts or are
actively suicidal
Pregnant users
These people should be referred to the community alcohol
team for assessment for in - patient detox.
Chlordiazepoxide is a Benzodiazepine that controls the symptoms of acute alcohol withdrawal,
including agitation, tremor, anxiety, autonomic over-activity and seizures. Chlordiazepoxide prevents
established alcohol withdrawal symptoms progressing into pre – delirium tremens, or delirium
tremens
The dosing of Chlordiazepoxide for alcohol detoxification is best supported by assessment of
withdrawal using CIWA-Ar as given in Guideline 18.19 above and this approach is encouraged in in-
patient settings. This also has a potential role in community settings
As long acting benzodiazepines, there is a risk of accumulation, toxicity and respiratory depression.
CAUTION: Additional care needs to be taken for individuals with:
1. Poor motivation to abstain from alcohol
2. Liver disease. There is a risk of accumulation in those with liver failure.
3. Risk of respiratory depression
4. Aged more than 70 years. There is a risk of accumulation in elderly patients.
5. Risk of dependence if prescribed over an extended period.
6. May exacerbate obsessional phobic and chronic psychotic states if prescribed over extended period.
Acamprosate
Acamprosate is a synthetic analogue used in the treatment of alcohol cravings. It is designed to
provide additional pharmacological support for individuals who want to maintain abstinence from
alcohol immediately following detoxification
Disulfiram ( Antibuse)
Disulfiram is an enzyme inhibitor. Which interferes with the metabolism of alcohol, leading to
accumulation of acetaldehyde in the blood. This reaction occurs within 10 minutes of drinking
alcohol and may lead to violent flushing, nausea and vomiting over a period of several hours.
Prescription of Disulfiram is used as a 6mth abstinence/ maintenance program of alcohol
Vitamins
300mgs oral Thiamine daily during the detoxification process.
High risk heavy drinkers who are malnourished-Thiamine 250mgs daily as Pabrinex intra muscular
IM 3-5 days (only as In-patient)
For individuals with incipient or established Wernicke’s Encephalopathy, the use of Pabrinex IM as
above, or 500mgs daily for 3-5 days is advised
GP’s
Statutory Drug Services
Self/Relative
A&E/General Hospitals
Social Services
Voluntary Organisations
Arrest Referral/DIP Team/Outreach Team
Probation
CARAT/Prison Teams
Housing
Children's Services
Hostels
Assessment
Community Detox
Residential Detox
Counselling up to 12 weeks
Pathways into Residential treatment
1:1 key work sessions
Brief interventions
Structured groups
Drop in sessions
Peer support
AA group
FAM ANON Group
Acupuncture
Women’s Group
Carers support
You can refer to THCAT using our referral form by fax,
email, post or telephone
Clients can self refer by telephone or attend at any of
our drop in sessions
There is also a dedicated free-phone number for clients
to call
Details can be found on our website www.rapt-
thcat.org.uk