How much Alcohol?

Are UK limits of Safe drinking Safe?

Regular excess drinking can take years off your life, study finds http://www.bbc.co.uk/news/health-43738644

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Drinking too much? Do’s & Don’ts

For many people Christmas is a time when alcohol consumption goes up and they can then bring the consumption back to Non- Hazardous levels. But for others it could be a time that makes them aware that there may be a problem with their drinking- difficulties in controlling, drinking more than what is considered as sensible drinking. Many may decide that they want to come off and that can happen with no ill consequences if they are not physically dependent. If they are physically dependent, medical supervision is important.

If this is the time that you have been thinking of reducing the harm caused by alcohol or want to stop, then the starting point may be to look at the quantities you are drinking in units.

Once you have calculated the units, take a self screening questionnaire- CAGE-

C- Has anyone- a friend, relative or carer ever asked you to cut down your drinking?

A- Do you ever get annoyed if someone asks you to cut down or stop drinking?

G- Have you ever felt guilty about your drinking?

E- Have you ever used alcohol as an eye opener ie used it first thing in the morning to steady your nerves or to function normally?

If you have answered YES to 2 or more questions above, you may be having a problem with the drink and it would be advisable to see your doctor or a specialist- Consultant Psychiatrist specialising in Addictions.

There are many new interventions available to tackle the problem with Alcohol- from reducing the amount of drinking to medically supervised detoxification, abstinence maintenance medications, anti- craving medications and relapse prevention strategies.

So think healthy, screen yourself and seek appropriate professional help.

And if using alcohol has become necessary to avoid withdrawals such as headaches, shaky hands, sweats, calming your nerves in the morning etc, then DON’T STOP AT ONCE as that can be dangerous. That would require a specialist assessment and a gradual reduction or a medically supervised detoxification which the specialist can help with.

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Alcohol and ‘White Collar’ Professionals

Walking through the streets of Central London today and thinking of Alcohol Awareness Week I was deliberating with my thoughts- Alcohol problems are found only in ‘blue collar’ population- is that really true? Not in my experience. I see ‘white collar’ professionals in clinical practice who develop a problematic relationship with Alcohol.

As reported in a recent BBC interview and campaigned by Alcohol Concern- Cymru, it often starts with recreational use where the reasons could be many- including coping with stress, using alcohol as a social lubricant to facilitate a subjectively improved social interaction, part of business networking world to name a few. This, when continues gradually results in gradual development of tolerance to the effects of alcohol and before long can be above ‘Hazardous Use’ giving way to ‘Harmful Use’ and ‘Dependence’.

In case stress is the underlying reason to seek shelter in Alcohol, then there are alternative and healthier ways to manage stress which I will be writing about in the next post.

But for now knowing what the considered safe limits are would be a start for Alcohol Awareness. For men, it is no more than 21 units and for women, no more than 14 units a week. These have to be spread out through the week with at least 2 days gap between drinking days. You can check your units consumption and calories on
Drinkaware

Look out for ‘Managing Stress Healthily’ and ‘Acute Effects of Alcohol’ posts coming up shortly.

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National Addictions Conference- Cardiff 2012

It was a matter of pride for hosting the Royal College of Psychiatrists Addictions Annual Conference in Cardiff this year. It is the first time that it was hosted in Cardiff. The feedback of the conference had been very good spanning from the topics covered to the minute details of the venue, the organisation and the hospitality. Dr Tony Jewell’s opening set the Welsh flavour and that carried on throughout. It was timely for the press release regarding the minimum pricing of alcohol to be released just before the conference as well. Listening to the news today, I picked up that the national alcohol consumption is being reported as going down with more health concerns, rising taxes and increased price to buy alcohol and based on that it was being argued that ‘minimum pricing’ should not be a strategic direction.

Most importantly, it is clear that pricing does have an impact on levels of consumption and given all the evidence on price- elasticity, the ‘marketing- mix’ used by the alcohol industry, the impact of availability and licensing, in my opinion, it becomes even more important to endorse ‘minimum pricing’.

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Motivational Interviewing- Addiction Psychiatry and Beyond Part 2

In trying to answer the question- ‘ Are we doing Motivational interviewing or are we doing Motivational Interviewing?”, it is important and only logical to understand what do we actually mean by Motivational Interviewing.

For me, there are a few givens here- that is- what MI is not. And if I were to qualify this, I mean we don’t do MI TO any one but rather do MI WITH someone. The word WITH in my experience is fundamental and crucial to any form of psychotherapy. In our jargon, we call it ‘therapeutic alliance’. Let me put it another way, wouldn’t it be better if I am able to understand and see the world from your perspective and work collaboratively with you to help you achieve your desired change? What is the likelihood of success, if you don’t establish any trust in the therapist?

MI in it’s fundamental approach is seeking to look at you as the sole agent of change and me as the MI practitioner, has the role of recognising that ‘change talk’ & evoking or extracting those internal resources that you have within your own self to facilitate that change.

So in some of the conversations that we may have in sessions, which may be regarding any change- alcohol control or abstinence, smoking cessation, tackling other substance misuse or behavioural addictions to name a few, if you tell me that you WANT to change, then MI will take us through the journey of going from ‘wanting’ to change to ‘willingness’ to change and ‘taking steps’ to change and then maintaining that change.

Of course, when you are talking about Substance Misuse the role of pharmacological options- Naltrexone for Opiates and Alcohol or newer treatments for alcohol as some examples, need to be kept in mind actively as well.

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Alcohol Addiction- New Breath Test for Family Courts

As a Consultant Psychiatrist, I am faced with the issue of dealing with Child Care Custody and Contact for people who have problems with Alcohol Use or Dependence. Not being a lawyer, commenting on the court decision making process is not within my expertise or domain but I do understand that adhering to treatment is an important factor for decisions regarding the child’s placement. I am often asked whether the individual in question has demonstrated this adherence to treatment.

Disulfiram (Antabuse) is a well researched medicine that is commonly used to maintain abstinence (remaining alcohol free) from alcohol. Different methods to monitor abstinence exist including Breath Testing for Alcohol, Urine tests, Blood tests and Hair Analysis.

But the good news is, that now with a new technology, measuring the breakdown products of Disulfiram in the breath is possible. So that means that by doing a breath test, it is possible to know whether someone has been taking their medication. This new technology can have huge implications-

– Can empower the person taking medication

– Can help in safely demonstrating concordance to treatment by passing this breath test

– Can help the Courts with their decision making process

– Can help the clinicians with better monitoring

I am sure everyone in the situation of their child care proceedings would agree with me that the joy of having ones child back is beyond any description in words!

I will give more details of this technology in my next post. By that time I would have had the opportunity to analyse this technology more rigorously and perhaps report on other uses of it. One quick benefit that comes to mind as I end this post is it’s use in Occupational and Employment related issues!

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