Alcohol Use Disorders Information for Patients and Carers

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1 Alcohol Liaison Service Alcohol Use Disorders Information for Patients and Carers Information

2 Drinking too much alcohol greatly increases your risk of serious health problems. Many different health problems are caused by drinking too much. Physical health problems caused by drinking alcohol include acute alcohol withdrawal, which occurs if a dependent drinker suddenly stops drinking; a condition called Wernicke s encephalopathy, which is caused by a lack of thiamine (also called vitamin B1) in the body; inflammation of the pancreas (called pancreatitis); and damage to the liver. Acute withdrawal from alcohol If you drink alcohol frequently over a long period of time, your body may become more tolerant to the effects of alcohol. This means that you may need to drink more to feel the effects of alcohol. You may also become dependent, meaning that you may have an overwhelming urge to drink alcohol and be unable to limit or stop yourself from drinking once you have started. If you become alcohol-dependent, you may develop withdrawal symptoms if you stop drinking or suddenly reduce the amount that you drink. Alcohol withdrawal can vary from mild problems, such as sleeping badly and feeling shaky and anxious, to much more serious, sometimes life-threatening, problems. If you have sudden and severe (known medically as acute) alcohol withdrawal, you may have some very serious symptoms. You may have fits (called seizures) where you may temporarily lose consciousness. You may also experience something called delirium tremens (sometimes called the DTs), which can include hallucinations (seeing and hearing things that aren t there) and feeling agitated and confused. 2

3 Staying in hospital for acute alcohol withdrawal If you are in acute alcohol withdrawal, you may be asked to stay in hospital to receive help with your symptoms. Some of the reasons for staying in hospital include: You have or are likely to develop seizures You have or are likely to develop delirium tremens You are under 16 years. You may also need to stay in hospital for help with acute alcohol withdrawal if there are additional considerations, for example, if: You are physically weak You have problems with memory and understanding You have several other health problems You do not have family or friends who can help you If you are admitted to hospital, your condition will be assessed and you will be offered medication to help treat the symptoms of withdrawal and prevent further symptoms developing. This is called medically assisted withdrawal (sometimes called detoxification or shortened to detox). Some people will need extra health checks while they are receiving help with withdrawal. Help with alcohol dependence If you are dependent on alcohol but your healthcare professional doesn t think you need to stay in hospital, you will be advised how to manage your alcohol intake. This will help prevent you having withdrawal symptoms. You will be given information about how to get help from your local alcohol support services. They will be able to advise you on how to avoid withdrawal symptoms if you want to stop drinking or reduce the amount you drink (called a planned withdrawal from alcohol). 3

4 Treating acute alcohol withdrawal If you are being treated for acute alcohol withdrawal, whether in hospital or not, your healthcare team will aim to minimise your withdrawal symptoms, prevent complications such as seizures and delirium tremens, and maintain your comfort and dignity. You should be offered information about how to contact local alcohol support services for further help. You should be offered drug treatment to help manage your symptoms and prevent further complications from developing. This should prevent your symptoms from getting worse. However, sometimes seizures or delirium tremens still develop in people who are being treated for acute alcohol withdrawal. If seizures or delirium tremens develop, your withdrawal drug treatment will be re-assessed to see if it needs to be changed. Delirium tremens If you develop delirium tremens, you should be offered drug treatment to help reduce your symptoms. Usually it will be in the form of a tablet but sometimes an injection or medication through a drip may be needed if symptoms are severe or you cannot or do not wish to take the medication by mouth. Other complications People being treated for alcohol withdrawal may have other alcohol related complications that also need treatment, and they may be referred for specialist care. Questions you might like to ask your healthcare team about acute alcohol withdrawal If I stop drinking will I get better? Will I have to stop drinking completely? What help can I get from my local alcohol support service? How long do I need to take medication for? How long will I have to stay in hospital? 4

5 What support will I receive outside of hospital? What help can I get to stay off alcohol after the detox? How can I prevent withdrawal symptoms happening again? Can you provide any information for my family/carers? Thiamine deficiency People who drink heavily over a long period of time often have low levels of thiamine (also called vitamin B1). This can be because they have poor eating habits and may often vomit. It can also be because alcohol can damage the stomach lining, affecting its ability to absorb vitamins from food, or because it damages the liver where the thiamine is processed. Lack of thiamine can lead to a condition that affects the brain and nervous system called Wernicke s encephalopathy. Symptoms include uncontrollable eye movements (these can be side-to-side, up-and-down or rolling movements), problems with walking and coordination, confusion and memory loss. However, some people may not show all of these symptoms, which can sometimes make it difficult for it to be recognised. If people with Wernicke s encephalopathy are given treatment early, their symptoms will improve and they may make a complete recovery. However, if treatment is not given, or is not given in time, their condition may become life-threatening and irreversible brain damage can occur, severely affecting short-term memory. If your healthcare professional thinks that you are at high risk of developing Wernicke s encephalopathy, you should be offered thiamine either as tablets or as an injection followed by tablets, depending on the situation. If your healthcare professional suspects that you have Wernicke s encephalopathy, you should be offered thiamine injections for at least 5 days followed by thiamine tablets. 5

6 Questions you might like to ask your healthcare team about thiamine deficiency What might happen if I don t receive thiamine? Can my symptoms be cured? How can I prevent thiamine deficiency happening again? What can I do to make sure I get enough thiamine? Alcohol-related liver disease The liver carries out many important functions in the body, one of which is to break down alcohol to allow it to be removed. Regular and heavy drinking over time can put a strain on the liver, leading to damage called alcohol-related liver disease. There are several different stages and types of alcohol-related liver disease: Fatty liver occurs when fat is deposited in the liver cells. It is the most common form of alcohol-related liver disease. Alcoholic hepatitis is inflammation of the liver. Cirrhosis is scarring that has spread throughout the liver. Liver failure (also called decompensation) occurs when the liver is so severely affected by alcoholic hepatitis or cirrhosis that it cannot carry out its normal functions. Diagnosing liver disease If blood tests (called liver function tests) have shown a problem with your liver, further tests should be done to rule out any causes of liver disease other than alcohol (such as hepatitis B or C infection). You may be offered a liver biopsy to investigate the type and severity of your liver disease. This will involve a small sample being taken from your liver using a needle under a local anaesthetic. Your doctor should discuss the risks and benefits of biopsy with you before you agree to have a biopsy or not. 6

7 Treating acute alcohol-related hepatitis Alcohol-related hepatitis can be caused by prolonged alcohol use over many years or sometimes by drinking a large amount of alcohol in a short period of time. It should not be confused with forms of hepatitis caused by viruses (for example, hepatitis A, B or C) and is not infectious. If you have acute alcohol-related hepatitis, you may need help to increase the level of nutrients in your body. Your healthcare team will be able to tell from your blood tests how severe your hepatitis is. If it is severe, you may be offered drugs called corticosteroids to help reduce the inflammation in the liver. Liver transplantation Most people with severe liver disease that has resulted in liver failure will have serious health problems that need urgent medical treatment. For some people who are treated and completely stop drinking, their symptoms can be controlled and their liver disease can improve, although the scarring will remain and cannot be cured. In others, treatment does not help. A liver transplant might be an option for some of these patients. If you have liver failure your healthcare team should discuss what treatment options are most suitable for you. Questions you might like to ask your healthcare team about liver disease What tests should I have and what will they involve? Where will these be carried out? What are the risks and benefits of liver biopsy? What treatments are available for alcohol-related liver disease? If I continue to drink, what will happen to my liver? If I stop drinking, will my liver recover? What management options are available for alcohol-related liver failure? 7

8 What will happen if a liver transplant is not an option for me? Alcohol-related pancreatitis The pancreas produces hormones in the body, such as trypsin, which is important for digestion, and insulin, which controls blood sugar levels. Long-term alcohol use can cause inflammation of the pancreas called pancreatitis. If left untreated, pancreatitis can cause malnutrition and lead to diabetes. There are two different types of pancreatitis: Acute pancreatitis is a sudden inflammation of the pancreas that occurs rapidly, often over a few days. Chronic pancreatitis is inflammation that develops gradually, often over years. Acute alcohol-related pancreatitis If you have acute alcohol-related pancreatitis, you will need help to increase the level of nutrients in your body. Where possible, you will be offered liquid food through a tube inserted into your nose and passed down into your digestive system. This will ensure that you are receiving adequate nutrition and may help to reduce inflammation of the pancreas. Some people may need to be given nutrients through a drip, directly into their blood. If you have mild acute pancreatitis you should not be given antibiotics unless they are needed for a reason other than protection against infection in the pancreas. Chronic alcohol-related pancreatitis Diagnosis If your healthcare team suspects that you have chronic alcoholrelated pancreatitis, they will ask you about your symptoms (abdominal pain and diarrhoea in particular), do an imaging scan of your pancreas and carry out blood and stool tests to find out if your hormone production has been affected. 8

9 The most effective scan to diagnose pancreatitis is called a CT scan (CT stands for computed tomography). This involves lying under a scanner that takes a series of X-rays to produce detailed images of the inside of your abdomen. Treating pain Sometimes surgery can help people with pain from chronic alcohol-related pancreatitis. If you have pain you should be offered referral to a specialist centre for an assessment. You may be offered an operation to help treat the pancreatitis if you have pain from a form of pancreatitis called large-duct (or obstructive) pancreatitis. If you have another type of pancreatitis called smallduct (or nonobstructive) pancreatitis and drug treatment is not relieving the pain, you may be offered a procedure to help relieve the pain. This may be the injection of an anaesthetic directly into the nerves involved in transmitting pain from the pancreas to the brain (called coeliac axis block and performed as an outpatient procedure) or cutting specific nerve branches (called splanchnicectomy and performed under a general anaesthetic). Alternatively, you may be offered another type of surgery to help treat the pancreatitis. If you are offered surgery or a procedure to help with the pain, your healthcare team should discuss with you in detail the type of treatment you need. Treating problems with digestion The pancreas makes chemicals called digestive enzymes that are essential for digesting food in the gut. In people with chronic alcohol-related pancreatitis, the inflammation may result in the gradual loss of the cells that make digestive enzymes, which can cause problems with digesting food. Symptoms of this include the presence of fat in stools and weight loss. 9

10 If you are found to have digestive problems caused by chronic alcohol related pancreatitis, you should be offered enzyme supplements to help reduce your symptoms. You should not be given enzyme supplements if you do not have digestive problems and your only symptom is pain. Questions you might like to ask your healthcare team about pancreatitis Will I recover if I stop drinking? What will happen if I continue to drink? What if I drink less or change my drinking habits? What treatments are available to relieve the pain? What are my options if medication does not relieve the pain? Can you explain how procedures to relieve pain work? Will I need to have an operation? Can you explain what the operation will involve? What are the risks of surgery? Will I develop diabetes? Will I need to take enzyme supplements? Contact Information The list below provides contact information for further, advice, information or support for people with alcohol-related physical health problems The Alcohol Liaison Nurse Service Monday to Friday 9am-5pm

11 Drinksense Adfam (please note this is not a helpline) British Liver Trust Free medical helpline: Need help with your drinking? The following services are free and confidential Substance 2 Solutions (CRI) is a health and social care charity working with individuals, families and communities across England and Wales that are affected by drugs, alcohol, crime, homelessness, domestic abuse and antisocial behaviour. Their accessible, community-based services offer flexible support ranging from advice and information to structured treatment programmes. Services seek to reduce harm and promote abstinence, and to help people recover from the damaging effects of substance misuse

12 Bridge is a substance misuse programme based in Northampton but is available throughout the county. Their aim is to provide practical support in relation to social aspects of recovery through sport and other activities as well as offering assistance with education, training and/or employment Rutland and Leicestershire: Swanswell Charity Drinkline National alcohol helpline Available 24hrs/day If you need this information in another format or language, please telephone Further information about the Trust is available on the following websites: KGH - NHS Choices - Ref: PI 723 April 2014 Review: January 2016

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