Alcohol Related Problems

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Alcohol use is a growing problem in society; alcohol is a factor in more than 5% of violent crimes, about 33% of domestic violence and 30-60% of child protection cases.

Contact us if you are suffering from alcohol-related problems.

Alchol use can be classified into:

  • Hazardous Drinking: Drinking over the recommended limits that is 21 units/week in men and 14 units/week in women or binge drinking > 8 units/day in men or 6 units/day in women.
  • Harmful Drinking: Drinking causing damage to the mental or physical health of the individual.
  • Dependent Drinking: Occurs if 3 or more of the followin occurred during the previous year (Source: NB Medical):
  1. A strong desire or compulsion to drink.
  2. Difficulties in controlling drinking.
  3. A Physiological withdrawal syndrome.
  4. Evidence of tolerance.
  5. Neglect of other pursuits due to time spent drinking.
  6. Persisting with drinking despite clear evidence of harm.

How do you calculate the number of Units of alcohol consumed?

Alcohol Units

Alcohol consumption should not exceed 28 units for men and 21 units for women in one week. In a single drinking session, alcohol consumption should not exceed four units in men and three units in women.

Alcohol units are calculated by using:

  • The volume of alcohol in millilitres
  • The alcohol strength – this is its percentage alcohol by volume (% ABV).

One unit is equivalent to 10 ml of pure alcohol:

  • One standard glass of wine 175 ml at 12% ABV = 2.1 units
  • One bottle of wine 750 ml at 12% ABV = 9 units
  • One pint of beer 568 ml at 3.5% ABV = 2 units
  • One pint of beer 568 ml at 5% ABV = 2.8 units
  • One single glass of spirits 25 ml at 40% ABV = 1 unit.

EXAMPLE: How to calculate number of units = 175mls x 12% ABV divided by 10 =175 x 0.12 =21 then divided by 10 = 2.1 units.

See this useful Blood Alcohol Level Calculator (via SR22 Insurance) as guideline.

How Alcohol is removed from the body after consumption:

About 90% of alcohol is metabolised (broken down) in the liver. The rest is eliminated through urination, exhalation, and perspiration. An average 70 kg man metabolises alcohol at a rate of one unit an hour. Other factors such as weight, age, and intake of food may change this.

Alcohol and Pregnancy.

Alcohol consumption in pregnancy can cause low birth weight, foetal alcohol syndrome (which causes birth deformities and low IQ) and miscarriages.

The Royal College of Midwives and the Department of Health (DOH) recommend a maximum of 1-2 units per week.

There is uncertainty about the effects of alcohol in the early stages of pregnancy when the main organs are formed. It is known that alcohol crosses the placenta barrier and can be found in the blood of the foetus. For this reason, some health Professionals advices complete abstinence in pregnancy.

General effects of excessive Alcohol Consumption.

Excessive alcohol consumption can cause short term and longer term problems. Some of the short term problems include:

  • Hypoglycaemia –low blood sugar.
  • Accidental injuries including falls, patients should also be screened for life threatening conditions including any signs of intracranial haemorrhage (bleeding into the brain).
  • Dehydration as it has a diuretic effect ( makes you pass more urine).
  • Hangover effects resulting from dehydration and may present with thirst, nausea, vomiting and or headaches.
  • It is known to “stimulate sexual desire but take away the sexual performance”.
  • Alcohol withdrawal symptoms and all patients who present with alcohol withdrawal symptoms should be screened for liver disease through blood tests and USS of the liver.
  • Known to be associated in 50% of violent crimes.
  • Associated with 33% of Domestic Violence.
  • Associated with 30-60% of child protection cases.

Some of the long term problems associated with excessive alcohol consumption include the following:

  • Hypertension & Heart disease.
  • Cancers.
  • Liver cirrhosis, cancer and liver failure.
  • Pancreatitis.
  • Infertility in males & females.
  • Alcoholic Gastritis and stomach ulcers.
  • Depression & other Mental Health conditions.

Effect of Alcohol on the brain and nerves.

Trying to give up drinking can be hard.Heavy drinkers of alcohol can become deficient in thiamine (Vitamin B1). This can lead to a neurological condition known as Wernicke’s encephalopathy. Patients with this condition may present with unsteady gait, diplopia or double vision, drowsiness, abnormal eye movements called nystagmus and confusion.

This can easily be mistaken for drunkenness. Emergency treatment is intravenous vitamin B1. If this is not administered, then this can cause death, and in survivors can result in a permanent disabling condition called Korsakoff’s psychosis can result. This is a disease where new memories cannot be formed.

Over time, alcohol use can cause dementia (gradual and progressive memory loss, as well as problems with the functioning of the nerves in the body (neuropathy).

Patients are routinely managed to prevent any of the above complications with regular prescription for Thiamine and strong vitamin B tablets.

Patients with alcohol withdrawal commonly present as an emergency. In most episodes of alcohol withdrawal initial management is by non-specialists including the General Practitioner(GP), It has been shown that early recognition and treatment of alcohol withdrawal can reduce mortality to 1% (that is reduce the death rate by 1%). Delayed treatment and missed diagnoses can result in complications and long term neurological damage as detailed above.

How common is alcohol withdrawal?

According to the Institute of Alcohol Studies factsheet for excessive and problem drinking in England and Wales 2007:

– 26% of adults aged 16 to 64 have a disorder of alcohol use
Of these, 38% are male and 16% are female
This is equivalent to about eight million people in England and Wales
– 21% of men and 9% of women are binge drinkers
A binge drinker is defined as someone who drinks over half the recommended number of units for a week in a single session
– About 4% of adults have alcohol dependence – this is equivalent to over one million people.

Alcohol withdrawal often presents with both medical and psychiatric signs and symptoms. A sudden reduction or cessation in alcohol intake causes a reactive hyperactivity of the central and autonomic nervous systems. Onset of alcohol withdrawal can occur as early as six hours after the last drink. Symptoms and signs of withdrawal can last between 24 hours and two weeks. The course of alcohol withdrawal usually occurs in two separate peaks:

Complications of alcohol withdrawal

The complications of alcohol withdrawal, in order of occurrence, are seizures, hallucinations, and delirium tremens:

  • Seizures. 50% of seizures occur on admission and 90% occur within nine hours of admission to hospital
  • Hallucinations. 50% of hallucinations occur within 21 hours and 90% occur within 64 hours of admission to hospital
  • Delirium tremens. Of the people that develop delirium tremens, 50% will develop the symptoms within 46 hours and 90% within 85 hours of admission to hospital.

Delirium Tremens

Delirium tremens is an acute episode of delirium caused by a sudden abstinence from alcohol. It occurs in those people with a long history of alcohol consumption and it can take place in up to 20% of patients with alcohol withdrawal. It usually occurs two to three days after the cessation or reduction of alcohol. Without treatment, it can last up to 72 hours and may result in death in 15% to 20% of patients.

The signs and symptoms of delirium tremens include:

  • Hallucinations
  • Excessive sweating
  • Profound agitation
  • A fever greater than 38.5°C
  • Tachycardia – a heart rate of greater than 100 beats a minute.

Complications of delirium tremens include:

  • Arrhythmias
  • Dehydration
  • Seizures
  • Death. Death occurs in 15% to 20% of patients due to cardiovascular and respiratory failure or cardiac arrhythmias-irregular heart beat. Correct management reduces mortality or death rate to less than 1%.

Wernicke’s Encephalopathy

Wernicke’s encephalopathy is a reversible condition caused by a deficiency of thiamine (vitamin B-1). People with alcohol dependence often suffer with malnutrition. This is because these patients replace food with alcohol. Thiamine deficiency is the result of malnutrition and a reduction in intake of the vitamin. There is a 70% reduction of thiamine absorption in malnourished patients who are abstaining from drinking alcohol. Absorption is further reduced if these patients continue to drink.

It is possible to precipitate Wernicke’s encephalopathy by ingesting glucose or carbohydrate on a background of thiamine deficiency.17 The mechanism for this is unclear, but is thought to be a result of glucose using up the remaining thiamine stores.

Thiamine deficiency causes lesions to develop within multiple parts of the brain, including the cerebellum, grey matter, thalamus, hypothalamus, and brainstem nuclei. These lesions are due to cellular oedema or swelling of the brain or cell death.

Wernicke’s encephalopathy usually begins several days after a sudden cessation or reduction in alcohol intake. The classical signs are:

  • Ataxia-unsteady Gait
  • Ophthalmoplegia – this is usually of the external recti muscles
  • Confusion or impairment of the short term memory.

Only 10% of patients present with these signs. Other signs include:

  • Nystagmus-jerky eye movements
  • Gaze palsies
  • Confabulation
  • Confusion.

Wernicke-Korsakoff Syndrome

Korsakoff’s syndrome can occur in patients with a severe dependence on alcohol and, often as a consequence, malnutrition. The signs of Korsakoff’s syndrome include:

  • Anterograde amnesia. This is an inability to formulate new memories – memories prior to the onset of Korsakoff’s syndrome remain intact
  • The preservation of immediate memory. The person is able to recall information immediately after it is mentioned.
  • The preservation of implicit memory. The person is able to learn new motor skills or show an improvement in complex tasks, even if they do not remember learning these skills. This results from a failure of memory formation and storage, although new information is processed normally
  • Confabulation. The person fabricates stories to fill in the gaps in their memory. This is often due to confusion of past and present events.

Korsakoff’s syndrome is also associated with a loss of spontaneity, drive, and emotional expression. The chronic form of this syndrome is known as Korsakoff’s psychosis.

It is possible to improve some aspects of short term memory by:

  • Encouraging the patient to stop drinking alcohol
  • Improving the patient’s diet
  • Advising regular vitamin supplements, including thiamine
  • Rehabilitation.

General amnesia is usually irreversible in patients with Korsakoff’s syndrome. Patients can learn to live independently, but most need residential care. Patients with Korsakoff’s psychosis usually have damage to the brain and the liver due to persistent heavy drinking over many years.

Simple withdrawal

  • This has a short duration of one to four days
  • It is associated with nausea, tremors, anxiety, sweating, and seizures
  • Seizures that relate to alcohol withdrawal are usually generalised and take place 12 to 48 hours after stopping alcohol
  • Seizures occurring more than 48 hours after stopping alcohol are rare

Complex withdrawal

  • This can sometimes last up to nine or 10 days
  • Symptoms and signs of complex withdrawal are more severe. It is associated with confusion, hallucinations, paranoia, and delirium tremens.

DRINKING RISK CATEGORY

LOWER RISK No more than 3-4units a day on a regular basis (Men) No more than 2-3 Units a day on a regular basis (Women)

INCREASING RISK More than 3-4 Units a day on a regular basis (Men) More than 2-3 Units a day on a regular basis (Women)

HIGHER RISK More than 50 units per week (or more than 8 units per day) on a regular basis (Men) More than 35units per week (or more than 6 units per day) on a regular basis (Women)
In both Men and Women – if you are drinking in the increasing risk range, it is easy to gradually slip into the higher risk category. (Source-www.nhs.uk/drinking)

THE 6-STEP PLAN TO REDUCE OR STOP DRINKING:

The above provides you with information about the effects of alcohol and the problems it can cause to your health, personal and or family life.

If you decide that you would like to give up or try and reduce your drinking habit in order to lower your overall risks there is a 6-Step Plan that you can follow to help you achieve your goal.

Step 1 Think about some of the benefits of reducing your drinking, these benefits may vary from one individual to another but may include- saving money, sleep better, more energy, reducing your risk of developing high blood pressure, might make you feel happier, may help you lose weight, you may be less likely to develop serious health problems such as heart and liver disease and there are a lot more good reasons to drink less or stop drinking.

Step 2 Set yourself goals, try and set goals that are realistic and you can stick to. Such goals may include:

  • I will NOT drink more than x-units each day.
  • I will NOT spend more than x-Pounds on alcohol per week.
  • I will have X-number of alcohol-free days per week.
  • I  will decide how much I am going to drink before I start drinking each time.
  • I will take up a new hobby or activities to do at the time I usually drink most to divert my attention from drinking.

Step 3 Know when you might slip up-no matter how much you want to change your drinking habits, there will be moments when it is easy to slip up and drink more than you would like to. Think of the times in the past when you have had to drink too much for example on social occasions, when you feel stressed, when you are lonely or depressed, when you are meeting new people in social situations and you feel nervous, when you are with your mates and you are supposed to keep up with them and there are many other situations when you are likely to slip up. Keep a note of such situations and circumstances when you might sleep up and be aware of this

Step 4 Plan now for the times and circumstances you might slip up. Think of such moments and circumstances and work out your coping strategies. Some suggested coping strategies:

  • Switch to low-alcohol beer.
  • Practice how to say NO to alcohol when it is offered to you in such circumstances.
  • Have a soft drink before each alcoholic drink
  • Eat a meal before drinking.
  • After work, go and play football, cricket, basketball, go to the Gym or the Cinema instead of going to the Pub.
  • If you feel stressed, chill out by going for a walk instead of drinking.
  • Replace alcohol with your favourite soft drink.
  • Let your mates, work colleagues, family know that you are cutting down on your drinking and ask for their support
  • If you are going out with people who drink heavily, try to avoid buying in rounds (or you may get the first round and then opt out.

Step 5 Find support if you need it, some people find it easier to change their habits if they have someone to talk to. Choose someone like your partner, a friend, a work colleague or someone else you know who wants to cut down their drinking. Find someone you can talk to easily, be honest at all times, do not be afraid to seek help. You may opt to speak to someone anonymously or you may just need some more information and advice on drinking and cutting down, call DRINKLINE on 0800 9178282 for 24 hour support.

Step 6 Stick to your goals, if you take your desire to cut down and lower your risk seriously, the 6-step plan really can help break the habit and change your level of drinking. Recognise that there is likely to be the odd setback along the way, so do not be discouraged if you have a slip or bad days just start the 6-steps again if you need to.

References and further reading:

Alcohol Concern
Alcoholic Anonymous
Turning Point
Royal College of Psychiatrists
British Medical Association
Institute of Alcohol Studies

If you think you may have a problem with drinking and wish to discuss this further, or if you desire treatment for an alcohol-related problem please contact us in confidence by completing our booking form, or sending an e-mail to info@callthephysician.com.