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Alcohol 2011


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Alcohol 2011

  1. 1. “ The Evil of Drink” <ul><li>Scottish Specialist Pharmacists in Substance Misuse Group </li></ul>
  2. 2. A little history <ul><li>Stone Age beer jugs c. 10,000 BC </li></ul><ul><li>“ Strong drink produces woe, sorrow, contentions, babbling, wounds without cause, redness of eyes” </li></ul><ul><li>Proverbs. 23:29-30 </li></ul><ul><li>“ Shaitan (Satan) wants only to excite enmity and hatred between you with intoxicants…… and turn you away from Allah and prayer. So will you not then abstain?” </li></ul><ul><li>Qur’an. 5:90-91 </li></ul>
  3. 3. <ul><li>London 1743: ≈ 18 million gallons of gin drunk – population 675,00. </li></ul>
  4. 4. and today: <ul><li>50.9 million litres of pure alcohol sold in Scotland in 2009: equivalent to 11.9l per person age >16 (9.6l in England & Wales). </li></ul><ul><li>Scots (age >16) on average drink </li></ul><ul><li>23 units/week (18 units in England & Wales). </li></ul><ul><li>Over a third of both men and women drank more than the recommended daily limit on the heaviest drinking day of previous week </li></ul><ul><li>In 2008 more than a third of 15 year olds had drunk alcohol in previous week, with 27% of those drinking more than adult recommended weekly limit. </li></ul><ul><li>“ Alcohol Statistics Scotland 2011”; ISD Scotland Publications </li></ul>
  5. 5. Cost to society of alcohol misuse 2007 £ 3,560,000,000 “ The Societal Cost of Alcohol Misuse in Scotland for 2007”; Scottish Government 2010
  6. 6. What else: <ul><li>Alcohol misuse – not just about binge drinking or dependence </li></ul><ul><li>The “gate-way” drug </li></ul><ul><li>Many know that sensible drinking guidelines exist </li></ul><ul><li>Less than half understand or recall them </li></ul>
  7. 7. What works: <ul><li>Increasing the price </li></ul><ul><li>Limiting the supply – density of outlets hours of sale </li></ul><ul><li>Raising the legal drinking age </li></ul><ul><li>Lowering the drink-driving limit </li></ul><ul><li>Screening and brief interventions </li></ul><ul><li>Health Promotion and School based education </li></ul><ul><li>Promotion of low or no alcohol drinks </li></ul>
  8. 8. How can pharmacists help?.. <ul><li>Advice on safe drinking practices </li></ul><ul><li>Patient screening </li></ul><ul><li>Delivery of alcohol brief interventions </li></ul><ul><li>Involvement in alcohol detoxes </li></ul><ul><li>Dispensing and supervision of relapse prevention medication </li></ul>
  9. 10. One pint of ordinary lager contains about the same amount of alcohol as? <ul><li>One glass of wine </li></ul><ul><li>One double whiskey </li></ul><ul><li>Two cans of cider </li></ul><ul><li>One bottle of alcopop </li></ul><ul><li>One single vodka </li></ul>Alcohol Quiz:
  10. 11. What are the current daily drinking limits for adults? <ul><li>2-3 units for women, 3-4 units for men </li></ul><ul><li>3-4 units for women, 4-5 units for men </li></ul><ul><li>1-2 units for women, 2-3 units for men </li></ul><ul><li>4-5 units for women, 5-6 units for men </li></ul>
  11. 12. How long does it take to become alcohol free? <ul><li>Depends on when you finish drinking </li></ul><ul><li>1hr per unit </li></ul><ul><li>4 hrs per unit </li></ul><ul><li>30 mins. per unit </li></ul>
  12. 13. A can (440ml) of 4.5% lager is equivalent to? <ul><li>2 plain digestive biscuits (115 calories) </li></ul><ul><li>A slice of pepperoni pizza (250 calories) </li></ul><ul><li>A small Yorkshire pudding (55 calories) </li></ul><ul><li>5 Jaffa cakes (221 calories) </li></ul>
  13. 14. Screening and Brief Interventions <ul><li>Scottish Government funding for Screening and Brief Interventions at GP practices and A & E. </li></ul><ul><li>Lack of research evidence means that a role for pharmacy has yet to be specified. </li></ul><ul><li>Advice and information, screening and assessment, brief interventions and referral. </li></ul>
  14. 15. Screening and Brief Interventions <ul><li>Recent pilot study in Grampian - 20 pharmacies </li></ul><ul><li>It is possible to screen, give an ABI and refer on in a community pharmacy setting. </li></ul><ul><li>Need tailored training which focuses on engaging pharmacy clients for the purpose of screening. </li></ul><ul><li>Support is required </li></ul><ul><li>Pharmacists’ worries about upsetting patients was largely unfounded </li></ul><ul><li>Patients who had received a BI had reduced their weekly drinking by more units than the control group, average FAST score reduced to <3 </li></ul>
  15. 16. Fast Alcohol Screening Test In the past year: <ul><li>How often have you had eight (six) or more drinks on one occasion? </li></ul><ul><li>How often have you been unable to remember what happened the night before? </li></ul><ul><li>How often have you failed to do what was expected of you because of drink? </li></ul><ul><li>Has anyone been concerned about your drinking and suggested you cut down? </li></ul>
  16. 17. Hazardous (risky) drinker: <ul><li>Consistently drinks over recommended limits, but without alcohol-related problems. </li></ul><ul><li>Harmful drinker: </li></ul><ul><li>Consumes more than the daily and weekly recommended limit, exhibiting clear evidence of alcohol related problems </li></ul><ul><li>Dependant drinker: </li></ul><ul><li>overpowering desire to drink that is difficult to control even if aware of harmful consequences. (also shows withdrawal symptoms, tolerance and self neglect.) </li></ul>
  17. 18. A brief intervention is: <ul><li>A time-limited conversation between a practitioner and patient focused on addressing hazardous and harmful alcohol use. </li></ul><ul><li>The aim is to: </li></ul><ul><li>Motivate hazardous or harmful drinkers to reflect on their drinking behaviour and reduce their alcohol consumption to lower risk levels . </li></ul>
  18. 19. SIGN 74 <ul><li>2003 but not “out of date” </li></ul><ul><li>Includes information about Brief interventions, Detox, and relapse prevention. </li></ul><ul><li>Highly recommended - </li></ul>
  19. 20. NICE GUIDELINES ( <ul><li>Part 1: Alcohol use disorders in adults and young people: prevention and early identification (June 2010) </li></ul><ul><li>Part 2: Alcohol use disorders in adults and young people: clinical management (June 2010) </li></ul><ul><li>Part 3: Alcohol use disorders: management of alcohol dependence (Feb 2011) </li></ul>
  20. 21. Alcohol detoxes <ul><li>Aim is to ease the symptoms of withdrawal, prevent seizures and delirium tremens without over-sedating the patient </li></ul><ul><li>Community vs. in-patient </li></ul><ul><li>Chlordiazepoxide is the drug of choice (diazepam if patient has history of seizures) </li></ul><ul><li>Regime is dependent on the patient and setting i.e. fixed dose or symptom triggered </li></ul>
  21. 22. Detoxification: <ul><li>Fixed chlordiazepoxide regime </li></ul>10mg 15mg 20mg 30mg Day 1 10mg qds 15mg qds 20mg qds 30mg qds Day 2 10mg tds 10mg qds 15mg qds 25mg qds Day 3 5mg tds 10mg tds 10mg qds 20mg qds Day 4 5mg bd 5mg tds 10mg tds 15mg qds Day 5 5mg nocte 5mg bd 5mg tds 10mg qds Day 6 - 5mg nocte 5mg bd 10mg tds Day 7 - - 5mg nocte 5mg tds
  22. 23. Vitamin supplementation <ul><li>Risk of Wernickes-Korsakoffs syndrome due to a lack of thiamine </li></ul><ul><li>Pabrinex IV or IM </li></ul><ul><ul><li>Treatment 2 pairs IV three times daily </li></ul></ul><ul><ul><li>Prophylaxis 1 pair IM daily </li></ul></ul><ul><li>Oral thiamine 100 mg three times daily for everyone at risk </li></ul>
  23. 24. Relapse prevention medication <ul><li>Disulfiram </li></ul><ul><ul><li>“ alcohol deterrent” due to unpleasant reaction to alcohol </li></ul></ul><ul><ul><li>Requires complete abstinence from alcohol therefore not suitable for everyone </li></ul></ul><ul><ul><li>Most evidence for it be taken under supervision </li></ul></ul><ul><li>Acamprosate </li></ul><ul><ul><li>Helps to stop the cravings </li></ul></ul><ul><ul><li>Patients can still drink on this </li></ul></ul><ul><li>Naltrexone (unlicensed) </li></ul><ul><ul><li>Helps to stop the cravings </li></ul></ul><ul><ul><li>Can not use this if patient is also on methadone </li></ul></ul>
  24. 25. Important drug interactions <ul><li>ALCOHOL + BENZODIAZEPINES </li></ul><ul><ul><li>Increased sedation </li></ul></ul><ul><li>ALCOHOL + DISULFIRAM </li></ul><ul><ul><li>Disulfiram-alcohol reaction </li></ul></ul><ul><li>Alcohol + metronidazole </li></ul><ul><ul><li>Disulfiram-like reaction </li></ul></ul><ul><li>Alcohol + any sedating drugs (e.g. antihistamines) </li></ul><ul><ul><li>Increased sedation </li></ul></ul><ul><li>Alcohol + warfarin </li></ul><ul><ul><li>Affected anticoagulant control </li></ul></ul>
  25. 26. Very important drug interactions! <ul><li>ALCOHOL + METHADONE </li></ul><ul><li>ALCOHOL + HEROIN </li></ul><ul><li>ALCOHOL + BENZOS </li></ul><ul><li>METHADONE + BENZOS </li></ul><ul><li>ALCOHOL + METHADONE + BENZOS </li></ul><ul><li>ALCOHOL + HEROIN + BENZOS </li></ul>
  26. 27. Alcohol and drug deaths + ( + ) =
  27. 28. Do not give methadone to a patient who appears intoxicated.
  28. 29. One pint of ordinary lager contains about the same amount of alcohol as? (568ml @ 3.5% = 2 units) 1 glass of wine- 175ml @ 12% 2 units 1 double whiskey – 50ml @ 40% 2 units 2 cans of cider – 880ml @ 5.6% - 8% 5–8 units 1 bottle of alcopop – 275ml @ 5.5% 1.5 units 1 single vodka – 25ml @ 40% 1 unit
  29. 30. What are the current daily drinking limits for adults? 2-3 units daily, and no more than 14 units in a week for women 3-4 units daily and no more than 21 units in a week for men and at least 2 alcohol-free days a week for both men and women
  30. 31. How long does it take to become alcohol free? Approximately 1hr per unit
  31. 32. A can (440ml) of 4.5% lager is equivalent to? 5 Jaffa cakes (221 kcal) 2 plain digestive biscuits (115 kcal) A slice of pepperoni pizza (250 kcal) A small Yorkshire pudding (55 kcal)