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