3 rd most deprived area Registered population 240,000 Young population Growth of 30,000 in next 5 years Highest increase will be in working age 34%

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1 THCAT

2 3 rd most deprived area Registered population 240,000 Young population Growth of 30,000 in next 5 years Highest increase will be in working age 34% Bangladeshi (much higher in under 20s) Recent data shows 3.9% Eastern European 2.8% Somali

3 Hospital Episode Statistics for 2007/08 report that 399 males and 128 females were admitted for conditions specifically caused by alcohol use While the number of alcohol related admissions to hospital in Tower Hamlets remain fewer than those observed for either City and Hackney or Newham, numbers nonetheless continue to steadily rise NI39: alcohol related admissions to hospital 2007/ alcohol related hospital admissions.

4 Ready availability of alcohol Bangladeshi and Somali young people consuming alcohol in contrast to their abstinent parents Approximately 50% abstain from alcohol consumption Lower overall consumption but relatively high levels of associated health and social harms Higher rates of alcohol abuse and dependency among A10 migrants coupled with issues prohibiting access to statutory services and a reliance on emergency services

5 Region Hospital admission for alcoholrelated harm. All persons DSR per 100,000 population Lower 95% CI Upper 95% CI Number of hospital admissions due to alcohol related harm Tower Hamlets City and Hackney Newham London England

6 From Healthy Lifestyles Survey (2009) Percentage of potential hazardous and harmful drinkers

7 3rd most deprived area Highest child poverty High unemployment Low education outcomes Poor housing quality High crime rate Social isolation High risk factors - Smoking - Lower physical activity - Poorer diet

8 PEER PRESSURE DEPRESSION BEREAVMENT UNEMPLOYMENT SOCIALISING STRESS SOCIAL ISOLATION SERIOUS MENTAL ILLNESS (Co-morbidity)

9 A UK 'unit' is 10ml of pure alcohol. Why this amount? It's all to do with how our bodies deal with alcohol. On average, healthy adult bodies can break down 10ml of alcohol in an hour. So, if you drink 10ml of alcohol, 60 minutes later there shouldn't be any left in your bloodstream. Where does the alcohol go? The liver breaks down most of it, though a small amount escapes through the skin, on the breath and in our urine.

10 What does 'ABV' mean? ABV stands for Alcohol By Volume. All pre-packaged alcoholic drinks must state how strong they are. Strength is shown as a percentage, with the letters ABV after the number. For example, most popular wines today are around 13% ABV, beers around 3.8% ABV. However super strength beers can be as much as 9.0 ABV. And they are becoming the norm with many drinkers Some wines are 9% ABV but the most popular ones average around 13%.

11 To find out how many units are in a drink, you need to know its volume in millilitres its %ABV strength Most packaged drinks state their volume in millilitres (ml). However, bottles of spirits and wine often state their volume in centilitres (cl). To get from centilitres to millilitres, simply stick another zero on the end. So, 75cl = 750ml. To find out how many units of alcohol are in a drink: Multiply the volume (in millilitres) by %ABV then divide the result by Units = (volume (ml) x % ABV) /1000

12 Government guidelines on alcohol units The Government's guidelines say that a male should not regularly drink more than 3-4 alcohol units a day and a female should not regularly exceed 2-3 units a day. An excellent guide to this can be found at

13 Alcohol and liver disease Alcohol induced liver disease accounts for over half of all the liver disease in the UK. Source: British Liver Trust Alcohol and weight gain By drinking 12 rums and coke a week you will consume 2880 empty calories. Alcohol and cancer After smoking, drinking alcohol is the biggest risk factor for cancers of the mouth and throat. The risk of breast cancer in women increases by about 7% for each additional drink taken every day. Source: Cancer Research UK

14 Stage 1 A social lubricant? After one or two drinks (1-3 units), we're more talkative and our heart rate speeds up a little, giving us an 'up' feeling. This is the effect that people refer to when they say alcohol makes them feel more sociable. The 'warm feeling', or flushes, is caused by alcohol in the blood making small blood vessels in the skin expand, allowing more blood to flow closer to the surface and lowering blood pressure at the same time.

15 Stage 2 Giddy up! After a couple more drinks (4-6 units) we feel light headed and our co-ordination and reaction times are impaired. Our ability to make decisions is also slowed down. All of these effects are cased by alcohol acting on nerve cells all around the body and making them work more slowly. Driving will be illegal (and dangerous) and operating machinery a bad idea.

16 Stage 3 I'm perfickly shober! Another few drinks (7-9 units) and most people will show definite outward signs of alcohol's effects. Reaction times are much slower, vision becomes blurry and speech is slurred. Drinking more than eight units at a time seriously overloads the liver. If we take care of ourselves in the days to come, it should repair itself but for tomorrow a hangover is pretty much guaranteed.

17 Stage 4 Nobody's friend... Drinking more than 10 units has most people staggering about the place. Accidents are commonplace as are fights caused by bumping into people who're easily upset by such things. This amount of alcohol will be affecting cells all over the body. In an effort to rid itself of the poison, the body tries to pass the alcohol out mixed with water in our urine. This is why alcohol makes us go to the loo a lot and is the cause of the dehydration that gives us morning-after headaches. Alcohol also attacks the gut, causing stomach upsets, heartburn, sickness and diarrhoea.

18 Drinking more than 30 units (that's about twelve pints of strong lager) is enough to knock most people out. From there, it's a short step to heart failure and breathing slowing to a stop. Even when people are already unconscious, alcohol in the stomach can continue to be absorbed and can reach lethal levels. People can also be sick and suffocate on their vomit. For these reasons, it's crucial never to leave very drunk people on their own.

19 CULTURAL SENSITIVITY NON-JUDGEMENTALISM ROLLING WITH RESISTANCE REALISTIC GOAL SETTING

20 Provision of widespread screening for alcohol consumption (new patients and at risk groups) Recording of alcohol consumption in the borough, 36 GP practices! Assessment and treatment (brief intervention and/or referral on to appropriate treatment) Wide range of GP practice staff trained and skilled to support people to change behaviour Brief intervention in primary care setting

21 Increase recording of alcohol Identify levels of harmful/hazardous drinking Provide community detoxification with appropriate support Skilled workforce in delivering range of health change interventions, widely applicable to other areas of health intervention Support general practice in working with other providers, specifically Community Alcohol Service

22 Level A screening and brief advice, units consumed, Audit C, provided by trained practice staff Level C (supported community detoxification) partnership with local alcohol provider and GP

23 Clients can be referred by any agency (with the clients consent), clients can also self refer Client is assessed by the practice nurse for suitability A request is made for the GP to arrange the clients bloods and Liver Function (LFT s) If suitability is met the nurse will contact the GP and request the detoxification medication Detoxification can be of 5 or 8 day duration depending on the level of weekly unit consumption

24 Physical Dependency on Alcohol Physical dependency = people drinking between units per week Age range A supportive person (partner, family member, friend or neighbour) who can be available during detox period. And a suitable home environment. If on assessment, the client does not meet the criteria refer for in-patient detoxification

25 A desire or sense of compulsion to drink Needing a drink first thing to offset withdrawals (Eye opener) Difficulty controlling use or unsuccessful efforts to cut down or control alcohol use physiological withdrawal when attempts at reduction or abstinence are made evidence of tolerance, such that increased amounts of alcohol is required to achieve intoxification or desired affect Salience of alcohol use. A great deal of time is spent in activities necessary to obtain alcohol, drink alcohol, or recover from the effects. Alternative pleasures are neglected. Continued drinking in the face of persistent or recurring social, Psychological or physical harm.

26 Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA- Ar) NAUSEA AND VOMITING TREMOR PAROXYSMAL SWEATS ANXIETY AGITATION TACTILE DISTURBANCES AUDITORY DISTURBANCES VISUAL DISTURBANCES HEADACHE, FULLNESS IN HEAD ORIENTATION AND CLOUDING OF SENSORIUM

27 People who have severe physical problems Those with history of fits/epilepsy and Delirium Tremens Heavy poly substance users Those developing/with signs of Wernicke-Korsakov symptoms People who have a history of suicide attempts or are actively suicidal Pregnant users These people should be referred to the community alcohol team for assessment for in - patient detox.

28 Chlordiazepoxide is a Benzodiazepine that controls the symptoms of acute alcohol withdrawal, including agitation, tremor, anxiety, autonomic over-activity and seizures. Chlordiazepoxide prevents established alcohol withdrawal symptoms progressing into pre delirium tremens, or delirium tremens The dosing of Chlordiazepoxide for alcohol detoxification is best supported by assessment of withdrawal using CIWA-Ar as given in Guideline above and this approach is encouraged in inpatient settings. This also has a potential role in community settings As long acting benzodiazepines, there is a risk of accumulation, toxicity and respiratory depression. CAUTION: Additional care needs to be taken for individuals with: 1. Poor motivation to abstain from alcohol 2. Liver disease. There is a risk of accumulation in those with liver failure. 3. Risk of respiratory depression 4. Aged more than 70 years. There is a risk of accumulation in elderly patients. 5. Risk of dependence if prescribed over an extended period. 6. May exacerbate obsessional phobic and chronic psychotic states if prescribed over extended period.

29 Acamprosate Acamprosate is a synthetic analogue used in the treatment of alcohol cravings. It is designed to provide additional pharmacological support for individuals who want to maintain abstinence from alcohol immediately following detoxification Disulfiram ( Antibuse) Disulfiram is an enzyme inhibitor. Which interferes with the metabolism of alcohol, leading to accumulation of acetaldehyde in the blood. This reaction occurs within 10 minutes of drinking alcohol and may lead to violent flushing, nausea and vomiting over a period of several hours. Prescription of Disulfiram is used as a 6mth abstinence/ maintenance program of alcohol Vitamins 300mgs oral Thiamine daily during the detoxification process. High risk heavy drinkers who are malnourished-thiamine 250mgs daily as Pabrinex intra muscular IM 3-5 days (only as In-patient) For individuals with incipient or established Wernicke s Encephalopathy, the use of Pabrinex IM as above, or 500mgs daily for 3-5 days is advised

30 GP s Statutory Drug Services Self/Relative A&E/General Hospitals Social Services Voluntary Organisations Arrest Referral/DIP Team/Outreach Team Probation CARAT/Prison Teams Housing Children's Services Hostels

31 Assessment Community Detox Residential Detox Counselling up to 12 weeks Pathways into Residential treatment 1:1 key work sessions Brief interventions Structured groups Drop in sessions Peer support AA group FAM ANON Group Acupuncture Women s Group Carers support

32 You can refer to THCAT using our referral form by fax, , post or telephone Clients can self refer by telephone or attend at any of our drop in sessions There is also a dedicated free-phone number for clients to call Details can be found on our website

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