Alcohol Resource File

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1 Alcohol Resource File By Sharon Johnson and Angela Turnbull

2 Alcohol Resource File By Sharon Johnson, Nurse Specialist in Addictions, North Northumberland Angela Turnbull, Outreach Worker, North Northumberland Updated: January 2004 This Resource file will be updated every year. It is also available to download as an Adobe Acrobat document (PDF) from: We would like to give special thanks to: Pam Robertson, Care Manager in Addictions, West Northumberland Bryan Hutchinson, Outreach Worker, West Northumberland Joyce Douglas, Secretary, North Northumberland Asier de Quadra, Graphic Designer, Communications Department 2004, Newcastle, North Tyneside and Northumberland Mental Health NHS Trust. Ref.1258_RI / Feb2004

3 Index Page 1. Introduction to Alcohol 3 2. Nature of Alcohol Problems 7 3. The Harmful Effects of Alcohol Guidelines for Referring to Alcohol Services Home Alcohol Detoxification Pack 15 Introduction Medical Schedule, 17 Criteria for Considering Home or Hospital Detoxification, 19 Guidelines for Home Alcohol Detoxification, Self Help Material for Clients and their Families Methods for Cutting Down Drinking Diary Personal Links & Local Services Further Support and Publication 33 Alcohol Resource File 1

4 2 Alcohol Resource File

5 1 Introduction to Alcohol What is Alcohol? The main component of all alcoholic drinks is ethanol (ethyl alcohol). A standard dose of alcohol is called a unit and a unit measure of drink contains 8g of ethanol. What is one unit of alcohol? Half a pint of average strength beer (approx 250ml) or A glass of 9% wine (1 unit) or A standard pub measure of spirits/fortified wine such as sherry or port (25ml) It takes the liver one hour to process one unit of alcohol Advice on Sensible Drinking The government's advice on sensible drinking has in recent years been for men to drink no more than 21 units, and women no more than 14 units, a week. It is now considered more helpful to view this guidance in daily terms and it is therefore recommended that men should drink no more than three to four units a day and women no more than two to three units a day. Men consistently drinking four units a day and women consistently drinking three units a day incur a progressive health risk. Alcohol Resource File 3

6 ABV = Alcohol by volume Alcopops Popular with young persons. Most of these have an ABV of 4-5.5% with a range of units from per bottle. The most well-known brands are the alcoholic lemonades and there are also alcoholic colas, fruit flavoured drinks and those using spirits such as Vodka and Bacardi. Spirits Most standard 75ml bottles of Whisky, Vodka or Rum have an ABV of around 40% containing units of alcohol. Wine Most wines are produced with an ABV of around 8-13% in a standard 750ml bottle containing 7-10 units of alcohol. Some wines may be stronger at 12 to 13% ABV while those from cooler climates such as Germany are usually 8 to 10%. Therefore a regular pub glass (125ml) of 12% wine is the equivalent of roughly 1.5 units. Fortified wines may be sometimes up to 17% strength. Sherry is usually produced with an ABV of 15-20% giving around units of alcohol for a typical 750ml bottle. Cider This varies in strength from the low alcohol varieties 3-8.5% up to the white ciders with an ABV of around 8.4%. Bottles usually contain 330ml; cans 440ml. A can of one of the stronger ciders contains around units of alcohol. Beer and Lager Most popular types of bitter beer are around 3.5 to 4.1% ABV - giving around units for a pint and 1.5 to 1.75 units for a 440ml can. The strength of lager beers can vary widely and ranges from very low strength drinks like non-alcoholic (0.02% ABV) to super strong lagers at anything up to 10%. But like bitter beers, many popular lagers are around 3.5-5% ABV providing units in a 440ml can and units in a pint. 4 Alcohol Resource File

7 Some people are more vulnerable to the immediate effects of alcohol depending on: Body Size - there are different ranges of blood volume depending on a person's size and weight and this means alcohol affects these people in different ways. Gender - A female tends to retain more fat and less fluid than a male body; so even if they are of a similar size and weight, drinking the same amount, the concentration of alcohol in the blood will be higher. Women are more sensitive to the immediate effects of drinking during ovulation (about 2 weeks before a period) and in the 2 or 3 days before a period. They are likely to feel the effects of alcohol more quickly at these times than they would normally. Women using the contraceptive pill do not experience this effect, but alcohol may take longer to process. Age - it appears that both young people and older people may process alcohol more slowly, and so they will have alcohol in their systems for longer. For women - women are more susceptible to some of the long-term effects of alcohol, and can develop liver disease at lower levels of drinking than men. Pregnancy - there has been some considerable concern about the effect of heavy alcohol use on the developing child. Some babies born to women who drink heavily in pregnancy may develop a condition know as Foetal Alcohol Syndrome (FAS) - a combination of growth deficiencies, central nervous system defects, lowered IQ and facial malformations. Research has shown that FAS is found in about one third of babies where the mother has drunk more than 56 units of alcohol a week throughout her pregnancy. Some research has identified FAS among babies of women drinking between 35 and 42 units a week. In general drinking alcohol should be avoided during pregnancy and brest feeding. Mental Health - despite initially helping to releive tension, alcohol can actually heighten anxiety. It is a factor in many cases of depression too, and it is estimated that alcohol has been involved in many suicide attempts. Dependency - Taken often and in large quantities, alcohol can develop into physical dependency on cessation of alcohol. This may include Alcohol Withdrawal Symptoms ie shaking, sweating, vomiting. Extreme cases - visual hallucination, Delerium Tremens (DT) and alcohol withdrawal seizures. Alcohol Resource File 5

8 6 Alcohol Resource File

9 2 Nature of Alcohol Problems Alcohol and Health Regular heavy alcohol consumption is known to be associated with a wide range of diseases and is a significant cause of premature death. However, there are many uncertainties. The Royal College of Physicians report summarises the medical complications of excess alcohol as follows: Nervous System Acute intoxication 'black-outs' Persistent brain damage Wernicke's encephalopathy Korsakoff's syndrome Cerebella degeneration Dementia Cerebrovascular disease Strokes, especially in young people Subarachnoid haemorrhage Subdural haematoma after head injury Withdrawal Symptoms Tremor Hallucinations Fits Nerve and Muscle Damage Weakness Paralysis Burning sensation in hands and feet. Alcohol Resource File 7

10 Liver Infiltration of liver with fat Alcohol hepatitis Cirrhosis and eventual liver failure Liver cancer Gastrointestinal System Reflux of acid into the oesophagus Tearing and occasionally rupture of the oesophagus Cancer of the oesophagus Gastritis Aggravation and impaired healing of peptic ulcers Diarrhoea and impaired absorption of food Chronic inflammation of the pancreas leading in some to diabetes and malabsorption of food Nutrition Malnutrition from reduced intake of food, toxic effects of alcohol on intestine, and impaired metabolism, leading to weight loss. Obesity, particularly in early stages of heavy drinking. Heart and Circulatory System Abnormal rhythms High blood pressure Chronic heart muscle damage leading to heart failure. 8 Alcohol Resource File

11 Respiratory System Fractured rib Pneumonia from inhalation of vomit Overproduction of cortisol leading to obesity, acne, increased facial hair, and high blood pressure Condition mimicking over-activity of the thyroid with loss of weight, anxiety, palpitations, sweating, and tremor. Severe fall in blood sugar, sometimes leading to coma. Intense facial flushing in many diabetics taking the anti-diabetic drug chlorprompamide. Reproductive System In men, loss of libido, reduced potency, shrinkage in size of testes and penis, reduced or absent sperm formation and so infertility, and loss of sexual hair. In women, sexual difficulties, menstrual irregularities, and shrinkage of breasts and external genitalia. Occupation and Accidents Impaired work performance and decision making. Increased risk and severity of accidents. Alcohol Resource File 9

12 10 Alcohol Resource File

13 3 The Harmful Effects of Alcohol BRAIN & CENTRAL NERVOUS SYSTEM Impaired behaviour, judgement., memory, concentration and coordination Drinker experiences mild euphoria and loss of inhibition as alcohol impairs regions of the brain controling behaviour and emotion. Alcohol impairs judgement, memory, concentration and coordination as well as inducing extreme mood swings and emotional outbursts. BRAIN DAMAGE & AFFECT Alcohol acts as a sedative on the Central Nervous System, depressing the nerve cells in brain, dulling, altering and damaging their ability to respond. Large doses cause sleep anaesthesia, respiratory failure, coma and death BRAIN DISORDERS & ADDICTION Long term drinking may result in permanent brain damage, serious mental disorders and addiction to alcohol. LUNGS High amounts of alcohol may cause breathing to stop; then death. Lowered resistence to infection. LIVER Chronic heavy drinking may cause alcoholic hepatitis (inflammation and destruction of liver cells) and then cirrhosis, irreversible lesions, scarring and destruction of liver cells. Impairs the liver's ability to remove yellow pigment and skin appears yellow (jaundice). Decreases production of blood-clotting, factors may cause uncontrolled bleeding Liver accumulates fat, which can cause liver failure, coma, death. OTHER AFFECTS ON CENTRAL NERVOUS SYSTEM Impaired visual ability Unclear hearing Dull smell and taste Loss of pain perception Altered sense of time and space Impaired fine motor skills Slows reaction Impaired sexual performance EYES Distorted vision and ability to adjust to lights. Pinpoint pupils and red eyes. EARS Diminishes ability to distinguish between sounds and perceive their direction. MOUTH Slurred speech. Dulls taste and smell, reducing desire to eat. THROAT Irritation and damage of lining or oesophagus, induces sever vomiting, haemorrhaging, pain and difficulty swallowing. Cancer. HEART Weakens the heart muscle and ability to pump (Cardiomyopathy). Heart enlargement, abnormal heart signs, and irregular heart beat. Increases blood pressure, risk of heart attack and strokes. Inhibits production of white and red blood cells MUSCLES Muscles become weaker and atrophy, pain, spasms and tenderness. STOMACH Irritation of stomach lining, peptic ulcers, inflammation, bleeding lesions, and cancer. REPRODUCTIVE SYSTEM Males & Females Sexual functioning can be impaired and deteriorate, resulting in impotence and infertility, sometimes irreversible. Females also have high risk of developing breast cancer. Pregnancy\ unborn babies Drinking during pregnancy significantly increases chances of developing a baby with Foetal Alcohol Syndrome; small head, possible brain damage, abnormal facial features, poor muscle tone, sleep and speech disorder and retarded growth and development. PANCREAS Significant risk of pancreatis, a chronic inflammation of pancreas INTESTINES Irritation of the lining of the intestinal tract and colon. Chronic drinking may result in inflammation, ulcers, and cancer or intestines and colon. Nausea, diarrhoea, vomiting, sweating and loss of appetite are common. Alcohol impairs small intestine's ability to process nutrients and vitamins Alcohol Resource File 11

14 12 Alcohol Resource File

15 4 Guidelines for Referring to Alcohol Services 1. Priority Referrals/Clients Needing Treatment/Accessing Services Pregnant Woman Physical dependence on alcohol; Physical dependence / Detox home or hospital based; Vitamin Replacement (vitamin B) Physical health problems, ie. liver disease Require complex physical / psychological / social health needs Referrals from Consultant Psychiatrist, either out-patient / in-patient, ie. deterioration in Mental Health Care co-ordination enhanced CPA Forensic issues harm to others, criminal damage, society but not stand alone, ie. "one off fighting or arguments"; may link with above Clients at risk vulnerability, dangers/risks Clients who show motivation to change, commitment Clients drinking above these amounts: Male - 50 units (weekly), Female - 35 units (weekly) 2. Prior to GP Referrals Has client engaged with GP? Do they attend GP appointments? Has GP queried client commitment and discussed size of alcohol problem? Venepuncture Have LFTs been taken prior to referral? How many weekly alcohol units consumed? Has length of time (history of alcohol) been established? Alcohol Resource File 13

16 3. Are Other Agencies Involved? Psychiatric admission/discharge from out-patient clinic risk of suicide, self harm. Specialist Intervention from Consultants / General Hospital, ie. Freeman Hospital, Wansbeck Gastroentology or Liver Unit. Is case active/open to social services, school, police? Imminent homelessness/poverty. Isolation, limited family resources, lack of opportunity. Domestic violence, risk to children, child protection, child in need. 4. Summary/Areas for Improvement In general, these guidelines to involve more than one of the above unless severe risk identified. Key resource providing a package of treatment and care flexible for Care Managers. Training package for other agencies, ie. Primary Care / Social Services (preventative) Employment / further training / links for clients and their families with lack of opportunities. 14 Alcohol Resource File

17 5 Home Alcohol Detoxification Pack Bryan Masterson and Eileen Kaner, June 1994 Introduction It is currently estimated that each health district has, on average, 43,000 people who drink more than the recommended limit, and that approximately 13,750 problem drinkers in each district are presently in contact with caring professions as a consequence of their alcohol misuse (Cooper 1994). In 1986, a survey of West Country family doctors showed that about half of all alcohol detoxifications took place at alcohol users homes (Stockwell et al. 1986). However Stockwell et. al (1986) reported concern about the lack of supervision in home detoxifications, the lack of structure to the detoxification procedures and the choice of medication used. Despite these reservations, the report that clients who elected to undergo home alcohol detoxification would have been unwilling to accept inpatient admission for detoxification (Stockwell et al. 1990) strengthens the case for home detoxification. Given the fact that many primary health care workers may already be involved in carrying out home detoxifications, the aim of this package is to provide a clear framework within which detoxifications can proceed. What is Home Alcohol Detoxification? It is a treatment designed to control both medical and psychological complications which may occur temporarily after a period of heavy and sustained alcohol use (Stockwell 1987) It is a treatment that takes place in the client s home, where they have access to family and peer support It is designed to take place over a seven day period It involves daily supervision and monitoring of the client in their home for at least the first three days, by a primary health care worker It includes administering a clearly structured reducing medication regime Alcohol Resource File 15

18 What are the benefits? It prevents inappropriate medicalisation of the problem including the adoption of the sick role by clients. It removes the stigma associated with hospitalisation and the loss of self esteem that this can cause. It maintains clients in their normal living environment. It fits in with community care, has the associated benefits of continuity of care and minimises cost. It s not for everyone Home Alcohol Detoxification is not suitable for all alcohol dependent clients. The client who has, over a period of several weeks consistently expressed a desire to stop drinking alcohol and who has only minor withdrawal symptoms may not need intensive supervision or medication (Cooper 1994). A small number of very physically dependent people may experience severe side effects when withdrawing from alcohol (Stockwell 1987) and should be in hospital. See Criteria for considering home or hospital detoxification (page 19). References: Cooper, D.B. (1994). Alcohol home detoxification and assessment. Radcliffe Medical Press, Oxford & New York. Stockwell, T., Bolt, E & Hooper, J. (1986). Detoxification from alcohol at home managed by general practitioners. B.M.J., 292, Stockwell, T. (1987). The Exeter home detoxification project. In: Stockwell, T & Clements, S. (eds) Helping the problem drinker: a new initiative in community care. Croom Helm, London. Stockwell, T., Bolt,L. Milner, et al. (1990). Home detoxification for problem drinkers: acceptability to clients, relatives and general practitioners, and outcomes after 60 days. British Journal of Addiction, 85 (1), Alcohol Resource File

19 Medical Schedule You may find one of the following reducing regimes suitable for the client, depending on the severity of their withdrawal symptoms. Both are equally valid depending on your prescribing procedure. Chlormethiazole (Heminevrin) should NOT be used in home detoxification because of its potential danger when used with alcohol. Chlordiazepoxide (Librium) Day Morning Noon 6pm Night Total 1 20 mgs 20 mgs 20 mgs 20 mgs 80 mgs 2 20 mgs 20 mgs 20 mgs 20 mgs 80 mgs 3 20 mgs 10 mgs 20 mgs 20 mgs 70 mgs 4 10 mgs 10 mgs 10 mgs 20 mgs 50 mgs 5 10 mgs 5 mgs 5 mgs 15 mgs 35 mgs 6 5 mgs 5 mgs 5 mgs 10 mgs 25 mgs 7 5 mgs mgs 10 mgs Grand Total 350 mgs Diazepam (Valium) Day Morning Noon 6pm Night Total 1 10 mgs 10 mgs 10 mgs 10 mgs 40 mgs 2 10 mgs - 10 mgs 10 mgs 30 mgs 3 10 mgs - 5 mgs 10 mgs 25 mgs 4 5 mgs - 5 mgs 10 mgs 20 mgs 5 5 mgs - 5 mgs 5 mgs 15 mgs 6 5 mgs mgs 10 mgs mgs 5 mgs Grand Total 145 mgs Alcohol Resource File 17

20 Vitamins Anyone who has abused alcohol for any length of time is likely to have been neglecting their diet and should be given oral vitamins. These are inexpensive and incur no harm to the client. We recommend that Vitamin B complex (Strong 2 tablets a day) and Vitamin C should be prescribed for the first month of detoxification. Further prescriptions should be left to your clinical judgement. Procedure For some clients it will be necessary to dispense the drug in daily bottles marked with instructions for that day, to avoid the risk of over-medication. Each day, the client should be handed the bottle with verbal instructions concerning the times medication should be taken. However there may be some clients for whom holding the medication might be a positive part of the therapeutic process. This should be left to your clinical judgement. 18 Alcohol Resource File

21 Criteria for Considering Home or Hospital Detoxification Detoxification Criteria for considering a HOME detoxification 1.Physical dependence on alcohol and a desire by the client to dry out at home 2.Adequate home support/supervision is available 3.Previous absence of severe withdrawal symptoms fits, DTs, violence 4.Where client has previously shown responsibility with drugs 5.No evidence of mental illness or severe ill health Criteria for considering a HOSPITAL detoxification 1.There is evidence of poor physical health, including: - Dehydration - Liver disorders - Heart conditions - Convulsions - Severe malnutrition - Presence of major acute infections, especially pulmonary - Presence of severe lung disease (risk of benzodiazepine induced respiratory depression) - Other factors such as health problems relating to ageing 2.There is evidence of poor mental health, including: - Severe depression - Suicide risk - Confused state - Memory impairment - Hallucinations Alcohol Resource File 19

22 3. History of repeated drug abuse 4. Need to remove client from the drinking environment as proven by previous experience 5. Consider need to relieve family for short period 6. Lack of domestic supervision or daily observation from a health professional 7. History of previous problematic withdrawal eg. DTs, fits, violence Aftercare Support and Referring on In the detoxification process, the management of symptoms or physical withdrawal is only the first step. Clients will require follow up support and counselling in order to maintain the changes in their drinking behaviour. Criteria for referring to sector mental health services eg. CPNs, Sector Psychiatrist 1. Serious anxiety or depressive symptoms 2. Complicating psychosis, dementia or other thought/memory impairment Criteria for referring to specialist drug and alcohol services eg. Community Substance Misuse Team or Substance Misuse Psychiatrist 1. Failure or inability to treat the client or family at the primary health care level 2. Need for social skills training, relapse management 3. Significant interpersonal difficulties 4. Moderate or severe personality disorders 5. Unsupportive social environment 20 Alcohol Resource File

23 Guidelines for Home Alcohol Detoxification 1. Full assessment Alcohol use Determine the client s past and present history of alcohol use and other drugs/medication. Use a tool such as Severity of Alcohol Dependence Questionnaire (SADQ). Only clients who are physically dependent on alcohol and who have experienced moderate or severe symptoms in the withdrawal from alcohol in the past are suitable for the home detoxification as described in this pack. General health of client Is the client physically able to go through a detoxification is there any history of epilepsy, fits, DTs? Is there a need for vitamin supplements? Is the client mentally able to go through a home detoxification? Is there any history of psychosis, clinical depression, suicidal tendencies? Client motivation Why now? Does the client want a detoxification or is there external pressure? Is this the best time to begin a detoxification? (weekends and holidays are not good) Does the client have a past history of abortive attempts to detoxify? Is the client prepared to refrain from alcohol use during detoxification? Support available for the client Does the client have a fixed address and stable living conditions? Will a family member/friend be available to provide support and to monitor the detoxification process? Advise the client that: Detoxification is part of an ongoing process A primary health care worker will visit for at least the first three days, administer medication and monitor progress The first hours are the most dangerous in withdrawal They may suffer from withdrawal symptoms and possible rebound effects They should actively plan short term goals You can offer referral to other agencies for ongoing support Leaflet two provides information about alcohol detoxification and should be given to the client Alcohol Resource File 21

24 2. Monitoring and Supervision The most effective use of resources would necessitate a shared care approach between GPs and other primary health care workers. GPs should be involved in the assessment and prescribing for clients while other health workers should monitor the client s progress throughout detoxification. This will involve daily visits to the client s home for at least the first three days of the detoxification process. Leaflet one provides information for monitoring detoxification and administering medication 3. Advising family and other supporters It is important to explain to the family etc. the process involved in home detoxification (cautions, dangers, likely occurrences) and to assess the levels of support they are willing to give to the client. Advise the family about: Adequate diet and fluid intake Aids to abstinence for the client Community support services available to the client and family Leaflet three provides information for the relative/friend You can order copies of the Home Alcohol Detoxification Pack from: The Home Detoxification Team Northumberland Community Substance Misuse Team Sextant House 2 Freehold Street Blyth, Northumberland, NE 24 2BA Telephone It contains information leaflets for carers, clients and primary health workers, as well as the information in Chapter 5 of this booklet. 22 Alcohol Resource File

25 6 Self Help Material for Clients Do I have an alcohol problem? The first thing to consider is how much you actually drink. Try to compile a drinking diary of what you had last week. Be careful to include all the drinks and remember that at home a glass of wine or spirits is often bigger than a pub measure! Was this a typical week? It you are drinking above the recommended limits do you think about cutting down? Are you... Thinking a lot about when you can next have a drink? Gulping your first drink quickly? Being conscious of how often you are the first person to finish a drink? Having more than the occasional hangover? Needing to have a drink before doing things or facing certain situations? Feeling sick, having the shakes, sweating in the morning or middle of the night? Spending more than you can afford on alcohol? Ordering doubles when it's your round? Often feeling that you need a drink? Increase in arguments and rows at home over drink? Being annoyed if others mention your drinking or your behaviour when you were drunk? Other people telling you that they are worried about your drinking? Feeling secretly uncomfortable about your drinking? Drinking when alone? Deliberately hiding the evidence of your drinking (lying about money, hiding drink and empty alcohol containers)? Starting to drink at times when you didn't before and earlier in the day? Alcohol Resource File 23

26 Myths and Facts What causes a hangover? Amount of alcohol and the effect on the body as it copes with breaking down the alcohol. Alcohol dehydrates the body and lowers the blood sugar level Additives added to drinking for flavour, colour and taste will add to the degree of a hangover. There is only one sure way to avoid a hangover and that is to drink less alcohol. Myths People falsely believe that 'drinking black coffee, having a cold shower or fresh air will sober them up'. Some Facts Alcohol is a depressant drug, even though it may feel stimulating when drunk at first. It slows down a person s reactions, its effects are greatly magnified if alcohol is taken with other depressant drugs such as tranquillisers or sleeping pills. Many people think alcohol warms you up but it doesn't. People may feel an immediate warmth after drinking due to the alcohol dilating the blood vessels on the surface of the body. Within minutes of drinking, some alcohol will be absorbed into the bloodstream. It takes the body (mainly the liver) at least one hour to break down one unit of alcohol. Alcohol is loaded with calories yet has no real nutritional value. Prolonged heavy drinking, combined with a poor diet, can lead to permanent brain damage. Excessive consumption can lead to health problems, eg stomach pains, vomiting blood, liver damage and a higher risk of certain cancers, high blood pressure, strokes etc. The chances of being in an accident increase if someone is drunk. Certain drinking patterns or behaviour can also lead to personal, family and work problems. 24 Alcohol Resource File

27 7 Methods for Cutting Down Keep a drinking diary Keep to my personal drinking rules Keep under a daily cut-off for alcohol Keep under my weekly grand total 21 units (men), 14 units (women) Pace my drinking Sip more slowly Take smaller sips Occupy myself while drinking Change my type of drink Drink for the taste Don't mix beer and spirits Imitate the slow drinker Put my glass down between sips Tell my friends "I'll buy my own drinks" Buy one round and then go 'solo' Give myself material rewards for successes Give myself mental rewards for successes Refuse drinks during some rounds Give up drinking with round-buying groups Dilute my spirits Eat before I drink Buy soft drinks inbetween alcoholic ones Take at least two days rest from alcohol per week Start drinking later Learn to refuse drinks Yes Maybe No Alcohol Resource File 25

28

29 8 Drinking Diary WEEK BEGINNING : DAY When Where Who with Why What How much Monday Tuesday Wednesday Thursday Friday Saturday Sunday Alcohol Resource File 27

30 28 Alcohol Resource File

31 9 Personal Links & Local Services Drink Line FREEPHONE (England and Wales). Drinkline offers free, confidential information and advice on alcohol, Monday to Friday 9.00am pm, Saturday & Sunday 6.00pm pm. Alcoholics Anonymous hours helpline Will also give information about AL-Anon family groups. Al-Anon (10.00am-10.00pm, 7 days) Al-Anon offers support to relatives and friends of alcoholics. Regional Alcohol Drug Centre Plummer Court, Cariol Place, Newcastle. Counselling Line am to 8.30pm Monday to Friday 10.00am pm Saturday & Sunday Escape Family Support Free confidential 24 hour helpline Offer 1-1 counselling, support from family, drop in centre and also outreach service, Berwick, Alnwick, Blyth, Hexham areas covered. Alcohol Resource File 29

32 Community Substance Misuse Team Sextant House, Blyth North East Council on Addictions (Newcastle HQ) Philipson House, 5 Philipson Street, Walker, Newcastle, NE6 4EN (Mon-Thu 8.30am-4.30pm, Fri 8.30am-4.00pm) NECA offers advice, information, support, brief intervention and counselling covering all addictions including alcohol, prescribed medication, illicit drugs, solvents, gases and gambling. The service is free and confidential. Signers can be arranged for people with impaired hearing. Interpreters can be arranged for other languages. Sorted (Morpeth) Northumberland's Substance Misuse Service for Young People Mon, Wed, Fri 2.00pm-5.00pm (for self-referral) Benmar House, Choppington Road, Morpeth, NE61 2HA Website: A service for young people aged under 18 years who have complex needs associated with substance misuse around alcohol, illicit drugs, prescribed drugs and volatile substances. The service operates on an outreach basis providing services within local communities. An initial referral form must be completed jointly with the young person by the referrer. Referral: self, any professional or worker in contact with the young person. 30 GP s Alcohol Resource File

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