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ALCOHOL
INTRODUCTIONFirst the bad news: 1 in 25 adults have a problem with drinking too much alcohol. These people need to consult their doctors for problems on average twice as often as other people. Alcohol consumption is closely related to a range of physical problems as well as psychiatric problems including clinical depression. Up to 65% of suicide attempts are linked with excessive drinking, and this is a factor in 20-30% accidents and accidental deaths. One in seven hospital admissions are alcohol related and people with alcohol related problems occupy one in five hospital beds. But drinking alcohol is not all bad… HEALTHY DRINKING LIMITSIt is a fact that drinking moderate amounts of alcohol is healthier than drinking none at all. For women the acknowledged healthy limit is 14 Units per week and for men it is 21 Units. Units of alcohol in drinks are starting to be written on labels, but you can calculate how much you are drinking by multiplying the percentage alcohol with the volume (in litres) that you drink. For example, in a bottle of wine (75cl = 0.75 litres) which has 12% alcohol, 0.75 x 12 = 9 units in the bottle. RISKS OF DRINKING TOO MUCHShort term: - whilst initially feeling warm and more relaxed, too much alcohol in the short term can cause disinhibition, doing something embarrassing, getting upset, doing or saying things you may regret, hangover, impotence, accidents, fights, vomiting, ending up unconscious or in the Emergency Department. People still die from falling unconscious and inhaling their own vomit. Medium term: - sleep disturbance, difficulty concentrating, difficulties in exams, at work and in relationships Long term: - liver damage, withdrawal syndrome (shakes, anxiety, sweats, craving) brain shrinkage, testicle shrinkage, growing breasts (men), diarrhoea, gastritis, pancreatitis and encephalopathy. TOTAL ABSTINENCE OR CONTROLLED DRINKING?Most people who drink, if they are being totally honest with themselves, will say they would prefer to be able to get their drinking under control rather than be totally abstinent for the rest of their lives. Sometimes someone’s entire lifestyle is fixed around alcohol and his or her alcohol ‘career’ may have lasted many years. If you realise that you are drinking too much for whatever reason, the sensible thing to do is to look at what you are drinking, when and why you are drinking it, and try to cut down bit by bit. This may seem obvious but it is easy to say to yourself ‘I must stop today’. The reasons it is better to plan a reduction in alcohol intake are: -
Someone who has liver failure or someone who finds that they struggle when working to control the amount they drink may need complete abstinence. It is the preferred lifestyle recommended by Alcoholics Anonymous. REDUCING THE AMOUNT YOU DRINKKeep a drinking diary for a few weeks to total up your daily and weekly intake. Look at where and when you consume most and use some of the tips below to reduce drinking at these times. Try to work towards a few alcohol-free days as consumption drops.
GOOD NUTRITIONAlcohol has lots of energy in it, so if you drink to excess chances are you may get overweight and eat less of a good diet because you are getting all your fuel from the drink. As a result alcoholics are frequently malnourished, particularly with regard to B vitamins. It is important to have a balanced and varied diet including all the major food groups and plenty of fruit, vegetables and foods rich in starch and fibre. DETOX – THE FACTSThe liver is often underestimated – yours efficiently and quietly gets on with metabolising all the elements processed through your gastrointestinal tract and it will continue to do so all your life unless critically damaged by disease or poisoning (ie by chronic overuse of alcohol). It has remarkable regenerative qualities, and we can get by with a ninth of the liver tissue we possess. That said, when it finally shows signs of disease, it has usually been struggling for a long time. There is no medical evidence to suggest that a ‘detox diet’ makes any long-term difference to the health of our bodies, and when it comes to alcohol most people think of it as a quick way to purge the body and get better quickly. Not so. Alcohol problem drinking evolves as habits and prioritised behaviour patterns over many years and it is these habits that are hard to break, and why controlling your drinking takes time and effort. The perfect drug to tackle the effects of alcohol withdrawal is alcohol itself, so the best way to withdraw is by gradually reducing what you drink. Substitute medication prescribed by a doctor may come with its own side effects and problems, so whilst it can help certain people it is generally reserved for use in hospital or in exceptional circumstances. SPECIALIST HELPSeeing your GP is a good way to start the ball rolling if you are concerned that you are drinking too much, but there is nothing to stop you starting to help yourself in the ways described above. Your doctor or nurse may discuss starting a drink diary, they can run tests to check the health of your body and can point you in the direction of support services and the local Alcohol Team who specialise in helping people to control their drinking problems. In Nottingham you can contact: -APAS – the Alcohol Problems Advisory service 0115 9414747 NADT – Nottingham Drug and Alcohol Team 0115 9418964 Alcoholics Anonymous 0115 9417100 Support for Parents 0115 9128011 / 9128035 DRINK DIARY Date: ……………
DRUGS
INTRODUCTIONSubstance misuse is on the increase and is dangerous. It causes huge problems to people’s health, careers, finances, relationships and criminal records. From violence, criminal behaviour, psychoses, assaults and rape, to anxiety, insomnia, flashbacks and paranoia. Here we give some information about commonly used drugs, how to minimize risk, and the problems they are often associated with. THE PROBLEM WITH USING OR MISUSING SUBSTANCESSimply put, you do not know what you are getting. Only medicines prescribed by a registered doctor with a medical degree are guaranteed to be what they claim, when they sign your prescription they accept full responsibility for the drug. Medicinal drugs have to go through years of research and testing before production. There are several phases of trials before they are used in Man. Even then, there is a system that continually monitors side effects reported by doctors and re-appraises their use. Pharmacists have a growing list of medicines they can sell for specific indications that are also safe, for most people, at the prescribed doses. You should always read the label because for some they may not be safe. None of this is true for drugs that are obtained illegally. Common side effects reported for psycho-active drugs are described later. SUPPLEMENTSThe message is that if you eat a healthy and balanced diet then dietary supplements are not usually required nor do they confer any health advantage. If you do not, then improving your diet is preferable to taking vitamin tablets. Research shows that eating from the main food groups in sensible proportions gives us all the essential nutrients, fuel, vitamins and minerals we need for an active life. This is far tastier than swallowing tablets and is healthier too. The only exception of note is iron in young women who need 2-3 times more than men to make up for monthly periods. It is a safe assumption to make that any drug that actually improves athletic performance is banned under competitive sporting rules, and if it isn’t banned then it probably doesn’t work. The one exception to this is Creatine, which is a food (not a drug) found in meat and fish. There is some evidence to suggest it may help muscle function in explosive sports (i.e. sprinting, weight-lifting) especially for those with a possible deficiency, for example vegetarians. You should be aware that the law as it stands does not require manufacturers of herbal remedies or supplements to put all the ingredients on the label. There have been cases where independent chemical analysis has not found the substance advertised, and others when additional substances have been found that could be dangerous. In one study 10-15% of supplements tested contained undisclosed substances, such as nandrolone, an anabolic steroid, that could give serious side effects (or could get you banned from sporting competition.) COMMON NON-PRESCRIBED DRUGS THAT CAUSE PROBLEMSAMPHETAMINES Amphetamines are psycho-stimulant drugs that produce a ‘high’ Side effects Regular users show poorer performance on cognitive testing, especially with memory and concentration. Amphetamines can produce temporary psychosis, and can trigger long-term psychotic conditions. Best way to stop The best way is to gradually reduce use with support. Drug Teams can help and these can be contacted by yourself (see end of article) or via your GP. Substitute drugs are not usually of much help. Expect a period of prolonged sleep with subsequent lethargy and a period of depression during which support, counselling and social support may help. CANNABIS Cannabis makes you feel relaxed and is misused more than any other recreational drug. Nine percent of people who use it just once become regular users and feel they depend on it. They have problems controlling how much they use and coming off. Only 17% of long-term users who try to stop have managed to do so twelve months later. Side effects Memory loss, poor concentration, anxiety, paranoia, precipitation of latent psychosis, deterioration in relationships and performance and possible infertility. Cannabis is ten times more carcinogenic than tobacco weight for weight. Withdrawal Symptoms These are mild and short-lived; insomnia, sweating, anxiety, restlessness, lethargy, anorexia, nausea, tremor and paranoia. Best way to stop Gradually reduce the amount and frequency you use, keep a ‘drug diary’, have a good varied diet and get regular light exercise. Get help and support from family, friends, or your doctor. COCAINE Cocaine (Charlie) or Crack cocaine is a psychostimulant and can be injected or snorted Side effects Excessive doses can cause severe medical problems such as hyperthermia, stroke, myocardial infarction (heart attack), heart failure and death. There is a dangerous and potentially deadly interaction between cocaine and alcohol. After-effects may include fatigue, depression, and paranoia with the ‘come down’ from the high. Best way to stop Contact your local drugs team or speak to your GP to get you started Cocaine anonymous 020 7284 1123 or www.cauk.org.uk CRYSTAL METH Methamphetamine is a psychostimulant drug used primarily for recreational purposes, but is sometimes prescribed for ADHD . Methamphetamine is highly psychologically addictive. It rapidly enters the brain and causes a cascading release of norepinephrine and dopamine (and to a lesser extent, serotonin) resulting in euphoria and the availability of undirected energy. Side effects Users become rapidly addicted and may become obsessed or perform repetitive tasks. Their health suffers in a variety of ways and their teeth rot. Crystal meth has been the subject of national outcry in the US where it has destroyed many people’s health and lives. It is on the increase in the UK and is should be avoided at all costs. ECSTASY Undoubtedly easier that saying 3,4-methylenedioxymetamphetamine or MDMA. Side effects This is an amphetamine and its most significant adverse effects, in addition to the dangers cited above, are hyperthermia and hyponatraemia or ‘water intoxication’, both of which may be fatal. Best way to stop Contact your local drugs team or speak to your GP to get you started HEROIN / DIAMORPHINE Extremely and rapidly addictive, injected or smoked, it gives a euphoric high followed by a come down. Side effects Withdrawal symptoms can be severe and those wishing to tackle their addiction are offered professional support as well as substitute medication, such as methadone, or a detox regime under medical supervision. See also Injecting Drugs. OTHER COMMON PARTY DRUGS In addition to those described above, other commonly used ‘party’ drugs are: - Ketamine (Special K) Flunitrazepam (Rohypnol) Gammahydroxybutyrate (GHB) Gammabutyrolactone (GBL) 1,4-butanediol (1,4 BD) These all have their specific dangers. The most worrying is reduced / altered perceptions and several have been associated with date-rape, assault and robbery. Drugs in combination can be more dangerous than drugs taken alone, this includes alcohol. INJECTING DRUGSInjecting drugs opens you up to a whole new level of risk. Problems fall into several categories: - Infection - such as HIV, Hepatitis B and C from other people
Thrombosis - blood clots forming where veins have been damaged
Overdose - an injected drug gets to the brain very quickly. If the drug is more concentrated than usual the effect can be unpredictable and catastrophic resulting in unconsciousness or death, either from respiratory depression or inhaling your own vomit when unconscious. MINIMIZING RISK
FOR INJECTERS:
HELPING A FRIEND TO COME OFF DRUGSDrugs can change a person’s personality and behaviour. They can be powerfully addictive psychologically and physiologically and stopping taking them is often very difficult. Support from family and friends can make a huge difference. Being a friend in circumstances like these means being approachable and caring, but also firm when it comes to boundaries and behaviour. This can be a hard balance to strike. Support and information is available from NHS Direct and the national drugs sites, and may be available in your locality too. Look at http://www.talktofrank.com/ for more information SPECIALIST HELP In Nottingham you can access help to find out more or come off drugs by seeing your GP. They will also be able to advise you about vaccination against Hepatitis B if you need it. Alternatively you can contact:- NADT – Nottingham Drug and Alcohol Team 0115 9418964 John Storer Clinic, The Ropewalk, Nottingham NG1 Cocaine anonymous 020 7284 1123 or www.cauk.org.uk UK National Drugs helpline: 0800 77 66 00 http://www.urban75.com/Drugs/helpline.html and http://www.talktofrank.com/ DRUG DIARY Date: ……………
Dr Tim Baker |
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