Pour Me A Life

pour me a life aa gillSo I was lucky enough to be lent a signed copy of AA Gill’s new book Pour Me A Life by a fellow Cambridge student who happens to be a friend of his and was at the book launch *thank you lovely person!*  I’ve been busy reading it and have devoured it in between our course texts.

AA Gill has been in recovery for over thirty years and this book talks about one particular year between his wife leaving and entering rehab – but that’s not entirely true because this is an autobiography so we learn a great deal about him and his life leading up to that point.  The book was an education where I learned about something I had experienced and couldn’t put into words – until now, Stendhal’s syndrome: being overcome by beauty.  This happened to me at St Peter’s Church in the Vatican City in Rome …..

There were a couple of passages that really resonated so to wet your appetite (and not risk infringement of copyright!)  I shall share just those and then links to some of the other reviews that have been written.

“It was for those whom the licensed day was not long enough to fit in the required pintage, for those of us who did alcohol overtime”

This next passage is beautiful and explains my experience of drinking so well:

“Booze is a depressant, a close relative of anaesthetic.  The symptoms of getting drunk are like those of being put out for an operation – initially, fleetingly, it offers a lift, a sense of transient joy, of confident light-headed freedom, it’s a disinhibitor; relaxes your shyness and natural reserve so you can feel socially optimistic in a room, can make a pass, tell a joke, meet a stranger.  But this is just the free offer to snag a punter.  Drink is, at its dark, pickled heart, a sepia pessimist.  It draws curtains, pulls up the counterpane.  It smothers and softens and soothes.  The bliss of drink is that it’s a small death.  The difference between you and us, you civilian amateur hobbyist drinkers and us professional, committed indentured alcoholics is that you drink for the lightness, we drink for the darkness.  You want to feel good we want to stop feeling bad.  All addictions become not about nirvana, but maintenance.  Not reaching for the stars but fixing the roof.”

This is what The Guardian had to say:

He delights in his own similes; they are produced one after the other as if spotlit and accompanied by canned laughter.

And The Telegraph:

And yet his inspirational passage on the joy of the English language, a thing “of peerless beauty and elegance”, should become a school-curriculum essential.

However, almost despite himself, his post-drinking life cannot fail to give hope to “those who still stagger” and despair.

A book that began by discussing lost time becomes one of recovered time, of a new way of life that is worth not only living but also celebrating.

And you can read Mrs D is Going Without’s review here.

Hear hear!  I love AA Gill’s writing & completely concur about his use of similes and that passage which displays his obvious delight in the English language.  This book is well worth your time and money 🙂

And talking of life after drinking – my friend the lovely Libby, who is 2 1/4 years sober, is about to take off on adventures with her dog Raisin.  She is leaving imminently and planning to cycle round the UK and is blogging about her journey here:

www.batgirlandraisin.com

In her words ” I am genuinely worried about the pub thing and would welcome some understanding, accountability and support. Cold (or maybe even hot), hungry, thirsty, tired, no doubt needing a wee too and nowhere to go with the dog except pubs…”

So sober warriors I’ll be cheering her on and hope that you will join me in supporting, reading, following and commenting on her blog as she heads off on her awesome alcohol free adventure 🙂  See this is what happens when you stop drinking! 😉

Friday sober movie night – Drinking to Oblivion

drinking to oblivionAs promised Louis Theroux’s Drinking to Oblivion has kindly been uploaded to Youtube so if you missed it or live outside the UK fill your boots! It is a hard watch but well worth it and there has been much press coverage since it aired.  Here’s some of the piece’s I’ve seen:

 

‘It made me scared about my drinking’: reactions to Louis Theroux’s Drinking To Oblivion (The Guardian)
Louis Theroux: Drinking to Oblivion review – you’ll worry about your alcohol consumption (The Guardian)
Louis Theroux: I can put away two bottles of wine after lunch (The Telegraph)
Review of Louis Theroux’s ‘Drinking to Oblivion’ (Castle Craig Blog)

And without further ado here it is:

 The thing to remember when you watch this is that none of these people started off drinking as much as they are now.  They all started drinking much less but as time and their tolerance and dependence increased so did the amount that they drank.  To start drinking at 1-2 bottles of vodka a day would probably kill many of us.  No-one starts at this point ………

 

Alcohol Sports Sponsorship Linked To Risky Drinking

alcohol and sports sponsorshipThis research was published by the Institute for Alcohol Studies in February this year looking at alcohol sports sponsorship and the link to risky drinking

 

A study released today finds an association between alcohol sponsorship of sport and risky drinking amongst schoolchildren and adult athletes. Published in the journal Alcohol and Alcoholism, this systematic review combines evidence from the UK and other countries on the impact of exposure to alcohol sports sponsorship on drinking behaviours.

Seven studies were included in the review that presents findings from 12,760 people in high-income countries including the UK, Australia and New Zealand. All the studies indicate that exposure to alcohol sports sponsorship is associated with increased levels of alcohol consumption and risky drinking amongst schoolchildren and sportspeople.

Two of the studies were conducted in the UK. Their findings were:

•    Amongst Welsh schoolchildren in Year 10 (age 14-15), awareness of alcohol sports sponsorship was linked to a 17% higher chance of boys, and 13% higher chance of girls, getting drunk at the weekend. When the same schoolchildren had both positive attitudes towards alcohol and awareness of alcohol sports sponsorship, the chances of getting drunk at the weekend were 26% higher for boys and 27% higher for girls.

•    Amongst UK university sportspeople, those receiving alcohol industry sponsorship were four times more likely to report hazardous drinking than non-sponsored sportspeople.

The report also includes a study of schoolchildren aged 13-14 from four EU countries which found exposure to alcohol sports sponsorship through viewing a major football tournament was linked to 70% increased chance of underage drinking.

The report’s author, Katherine Brown, is Director of the Institute of Alcohol Studies. She said:

“It is of great concern to see that sport, which should be viewed as a healthy, family friendly activity, is potentially putting our children and athletes at risk due to sponsorship deals with alcohol companies.”

“There is strong evidence that exposure to alcohol marketing leads young people to drink at an earlier age and to drink more if they already do so. This is why the OECD and World Health Organisation have called on governments to investigate the introduction of alcohol advertising bans.”

“Major alcohol brands are prominent in almost every high profile sporting event today, exposing millions of children to advertising and building positive associations that could be damaging in the long term.”

Read the full article in Alcohol and Alcoholism 

The advertisment above says it all really …..

Effects of Different Alcohol Taxation and Price Policies on Health Inequalities

uk taxation and alcoholSo before we discuss this new research looking at and exploring the estimated effects of different alcohol taxation and price policies on health inequalities from a mathematical modelling study point of view I thought it beneficial to provide some context.  The graphs to the left show the tax receipts for the UK govt in 2015.  As you can see alcohol duty plays an important role in raising taxes for the govt and makes up 1/6th of the minor tax take, not so minor after all at £10.5 billion.

Here’s the study abstract:

Introduction

While evidence that alcohol pricing policies reduce alcohol-related health harm is robust, and alcohol taxation increases are a WHO “best buy” intervention, there is a lack of research comparing the scale and distribution across society of health impacts arising from alternative tax and price policy options. The aim of this study is to test whether four common alcohol taxation and pricing strategies differ in their impact on health inequalities.

Methods and Findings

An econometric epidemiological model was built with England 2014/2015 as the setting. Four pricing strategies implemented on top of the current tax were equalised to give the same 4.3% population-wide reduction in total alcohol-related mortality: current tax increase, a 13.4% all-product duty increase under the current UK system; a value-based tax, a 4.0% ad valorem tax based on product price; a strength-based tax, a volumetric tax of £0.22 per UK alcohol unit (= 8 g of ethanol); and minimum unit pricing, a minimum price threshold of £0.50 per unit, below which alcohol cannot be sold. Model inputs were calculated by combining data from representative household surveys on alcohol purchasing and consumption, administrative and healthcare data on 43 alcohol-attributable diseases, and published price elasticities and relative risk functions. Outcomes were annual per capita consumption, consumer spending, and alcohol-related deaths. Uncertainty was assessed via partial probabilistic sensitivity analysis (PSA) and scenario analysis.

The pricing strategies differ as to how effects are distributed across the population, and, from a public health perspective, heavy drinkers in routine/manual occupations are a key group as they are at greatest risk of health harm from their drinking. Strength-based taxation and minimum unit pricing would have greater effects on mortality among drinkers in routine/manual occupations (particularly for heavy drinkers, where the estimated policy effects on mortality rates are as follows: current tax increase, −3.2%; value-based tax, −2.9%; strength-based tax, −6.1%; minimum unit pricing, −7.8%) and lesser impacts among drinkers in professional/managerial occupations (for heavy drinkers: current tax increase, −1.3%; value-based tax, −1.4%; strength-based tax, +0.2%; minimum unit pricing, +0.8%). Results from the PSA give slightly greater mean effects for both the routine/manual (current tax increase, −3.6% [95% uncertainty interval (UI) −6.1%, −0.6%]; value-based tax, −3.3% [UI −5.1%, −1.7%]; strength-based tax, −7.5% [UI −13.7%, −3.9%]; minimum unit pricing, −10.3% [UI −10.3%, −7.0%]) and professional/managerial occupation groups (current tax increase, −1.8% [UI −4.7%, +1.6%]; value-based tax, −1.9% [UI −3.6%, +0.4%]; strength-based tax, −0.8% [UI −6.9%, +4.0%]; minimum unit pricing, −0.7% [UI −5.6%, +3.6%]). Impacts of price changes on moderate drinkers were small regardless of income or socioeconomic group. Analysis of uncertainty shows that the relative effectiveness of the four policies is fairly stable, although uncertainty in the absolute scale of effects exists. Volumetric taxation and minimum unit pricing consistently outperform increasing the current tax or adding an ad valorem tax in terms of reducing mortality among the heaviest drinkers and reducing alcohol-related health inequalities (e.g., in the routine/manual occupation group, volumetric taxation reduces deaths more than increasing the current tax in 26 out of 30 probabilistic runs, minimum unit pricing reduces deaths more than volumetric tax in 21 out of 30 runs, and minimum unit pricing reduces deaths more than increasing the current tax in 30 out of 30 runs). Study limitations include reducing model complexity by not considering a largely ineffective ban on below-tax alcohol sales, special duty rates covering only small shares of the market, and the impact of tax fraud or retailer non-compliance with minimum unit prices.

Conclusions

Our model estimates that, compared to tax increases under the current system or introducing taxation based on product value, alcohol-content-based taxation or minimum unit pricing would lead to larger reductions in health inequalities across income groups. We also estimate that alcohol-content-based taxation and minimum unit pricing would have the largest impact on harmful drinking, with minimal effects on those drinking in moderation.

To read the full research article go here.

Bearing in mind that I featured a great piece only recently looking at alcohol and health inequality once again the case for minimum unit pricing is robust and these findings conclude that they would not impact on those who drink moderately which has been the biggest and loudest reason given not to implement to date.

And once again Scotland lead the way in collaboration with the University of Sheffield:

Model-based appraisal of the comparative impact of Minimum Unit Pricing and taxation policies in Scotland (PDF)
To achieve the same reduction in alcohol-related deaths among hazardous and harmful
drinkers as a 50p minimum unit price, a 28% increase in alcohol taxation would be required.

But no we seem to be heading in the opposite direction yet again!

The HMRC Alcohol Strategy Modernising alcohol taxes to tackle fraud and reduce burdens on alcohol businesses (PDF)

Of course we need to REDUCE the tax burden on alcohol businesses instead 🙁

Alcohol consumption among university students in the British Isles

university student drinkingSo it feels like we’ve hit pretty much every other demographic from young person to older people except university students.  So to the left is the university drinking league table for 2015 where they quizzed 1,649 UK university students via an online survey, asking all about your drinking habits and attitudes towards alcohol.  And here is the research paper that looks at university student drinking from a research and academic point of view!  My current university it seems is 46th on the list out of 50.

Abstract

Background

Alcohol is a leading cause of global suffering. Europe reports the uppermost volume of alcohol consumption in the world, with Ireland and the United Kingdom reporting the highest levels of binge drinking and drunkenness. Levels of consumption are elevated among university students. Thus, this literature review aims to summarise the current research on alcohol consumption among university students in the Republic of Ireland and the United Kingdom.

Methods

MEDLINE, CINAHL, EMBASE and PsychInfo were systematically searched for literature from January 2002 until December 2014. Each database was searched using the following search pillars: alcohol, university student, Ireland or the United Kingdom and prevalence studies.

Results

Two thousand one hundred twenty eight articles were retrieved from electronic database searching. These were title searched for relevance. 113 full texts were retrieved and assessed for eligibility. Of these, 29 articles were deemed to meet inclusion criteria for the review. Almost two thirds of students reported a hazardous alcohol consumption score on the AUDIT scale. Over 20 % reported alcohol problems over their lifetime using CAGE while over 20 % exceed sensible limits each week. Noteworthy is the narrowing of the gender gap throughout the past decade.

Conclusion

This is the first review to investigate consumption patterns of university students in Ireland and the United Kingdom. A range of sampling strategies and screening tools are employed in alcohol research which preclude comparability. The current review provides an overview of consumption patterns to guide policy development.

To read the full paper go here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4759952/

Edited to add: for anyone who missed the excellent Louis Theroux  documentary Drinking to Oblivion last night on BBC 2 it’s showing on iPlayer for the next 29 days here:

Drinking to Oblivion

No link has gone up on Youtube yet but as soon as it does I’ll share it here for my non UK based readers 🙂

 

Risks and Benefits of Nalmefene in the Treatment of Adult Alcohol Dependence

nalmefene risks and benefitsSo this was sent to me by a lovely GP friend of mine *waves hello*! and was a systematic literature review and meta-analysis of published and unpublished double-blind randomized controlled trials with regard to nalmefene, a new drug that was rubber stamped by NICE within the last few years for treatment of moderate adult alcohol dependence (defined as drinking no more than 1/2 a bottle of wine a day so approx 6 units).  I’ve written about it lots and you can read all my posts about it here.

I’m all for any treatment option that supports and helps alcohol dependence and people’s desire to cut down or stop but the evidence supporting it needs to be robust seeing as there is a cost to the NHS involved.  A quick search of the internet uncovers that this drug is £3.48 a tablet (that’s £1,270 per annum in drug costs) so not cheap!!

Here’s the full abstract:

BACKGROUND: Nalmefene is a recent option in alcohol dependence treatment. Its approval was controversial. We conducted a systematic review and meta-analysis of the aggregated data (registered as PROSPERO 2014:CRD42014014853) to compare the harm/benefit of nalmefene versus placebo or active comparator in this indication.

METHODS AND FINDINGS: Three reviewers searched for published and unpublished studies in Medline, the Cochrane Library, Embase, ClinicalTrials.gov, Current Controlled Trials, and bibliographies and by mailing pharmaceutical companies, the European Medicines Agency (EMA), and the US Food and Drug Administration. Double-blind randomized clinical trials evaluating nalmefene to treat adult alcohol dependence, irrespective of the comparator, were included if they reported (1) health outcomes (mortality, accidents/injuries, quality of life, somatic complications), (2) alcohol consumption outcomes, (3) biological outcomes, or (4) treatment safety outcomes, at 6 mo and/or 1 y. Three authors independently screened the titles and abstracts of the trials identified. Relevant trials were evaluated in full text. The reviewers independently assessed the included trials for methodological quality using the Cochrane Collaboration tool for assessing risk of bias. On the basis of the I2 index or the Cochrane’s Q test, fixed or random effect models were used to estimate risk ratios (RRs), mean differences (MDs), or standardized mean differences (SMDs) with 95% CIs. In sensitivity analyses, outcomes for participants who were lost to follow-up were included using baseline observation carried forward (BOCF); for binary measures, patients lost to follow-up were considered equal to failures (i.e., non-assessed patients were recorded as not having responded in both groups). Five randomized controlled trials (RCTs) versus placebo, with a total of 2,567 randomized participants, were included in the main analysis. None of these studies was performed in the specific population defined by the EMA approval of nalmefene, i.e., adults with alcohol dependence who consume more than 60 g of alcohol per day (for men) or more than 40 g per day (for women). No RCT compared nalmefene with another medication. Mortality at 6 mo (RR = 0.39, 95% CI [0.08; 2.01]) and 1 y (RR = 0.98, 95% CI [0.04; 23.95]) and quality of life at 6 mo (SF-36 physical component summary score: MD = 0.85, 95% CI [-0.32; 2.01]; SF-36 mental component summary score: MD = 1.01, 95% CI [-1.33; 3.34]) were not different across groups. Other health outcomes were not reported. Differences were encountered for alcohol consumption outcomes such as monthly number of heavy drinking days at 6 mo (MD = -1.65, 95% CI [-2.41; -0.89]) and at 1 y (MD = -1.60, 95% CI [-2.85; -0.35]) and total alcohol consumption at 6 mo (SMD = -0.20, 95% CI [-0.30; -0.10]). An attrition bias could not be excluded, with more withdrawals for nalmefene than for placebo, including more withdrawals for safety reasons at both 6 mo (RR = 3.65, 95% CI [2.02; 6.63]) and 1 y (RR = 7.01, 95% CI [1.72; 28.63]). Sensitivity analyses showed no differences for alcohol consumption outcomes between nalmefene and placebo, but the weight of these results should not be overestimated, as the BOCF approach to managing withdrawals was used.

CONCLUSIONS: The value of nalmefene for treatment of alcohol addiction is not established. At best, nalmefene has limited efficacy in reducing alcohol consumption.

So not what I would call robust then ……. limited efficacy in reducing alcohol consumption.  Based on this research review maybe NICE should be doing a review of their guidance and recommendations then seeing as it was controversial in the first place?

 

Friday Sober Jukebox – Weapon Of Choice

Sober jive time!

So one of my sober buddies recently had an article published on Medium which is worth a celebratory sober jive don’t you think? 😉  It’s called ‘how and why I decided to live alcohol free’ and is the first part of a series.  We felt that this tune reflected the sentiment seeing as booze is no long our weapon of mass destruction choice 🙂  Congrats on being published lovely & more importantly on 2 years AF!!

Sometimes, I feel that I am a freak of nature as a Person Who Doesn’t Drink. I’m Irish, so, you know, what are we most famous for? (I’m not talking about red hair and fiddle-playing).

I was a teenager in the tail end of the 1980’s and the start of the clubbing 90’s. We were supposedly “ladettes” who drank in fields at rural discos before moving to underage drinking in unpopular pubs that turned a blind-eye to the fact that its new patrons were all 16 or 17.

A former lawyer, I cut my teeth in the City of London in the work hard / play hard days of the late 1990’s when it was cool to match the boys, bottle for bottle, on an empty stomach – whatever the consequences.

I’m now a mother in my early 40s – so that means the only way of wading through the supposed horror that is modern-day parenting is by counting down the minutes until I can open a bottle of wine (according to a slew of Facebook graphics I see shared day on day). A middle-class, urban parent, living a Netflix / box-set marriage which surely goes hand in hand with a nice Pinot Noir and some artisan, organic chocolate.

So why do I find myself, aged 43, approaching the end of my second year of having consumed no alcohol whatsoever? (Not counting the odd tiramisu made by a chef who’s heavy-handed with the liqueur).

I don’t think its a coincidence that I stopped drinking not long after I turned 40. It’s a cliché, but there is something about that milestone that turns so many of us towards introspection. We look at the life we are leading now, painfully aware that the years don’t stretch infinitely beyond us any more. This is it. This is the life we have.

In my particular case, I couldn’t escape the fact that my own beloved mum died when she was only 56. Turning 40 I was entering the decade in which she had first been diagnosed with breast cancer. The medical link between excessive alcohol intake and cancers of all type was becoming harder and harder to ignore, no matter how much finger-in-ear “la la la-ing” I did.

So I had to start thinking about whether I was living the best life that I could. When I turned the icky, uncomfortable inward gaze towards the reality of how I spent my days, I could not avoid the annoying, inconvenient truth that I drank more than I wanted to drink. Sometimes a lot more.

This was something that had gnawed at my sub-conscious before turning 40 of course. For quite a few years I’d made various attempts to reduce drinking, keeping it to weekends, only on nights out and so on. Sadly, when your mind associates relaxation with alcohol above all else, it doesn’t take much (a particularly stressful day, a child that has a meltdown, a friend coming over) to allow you to make an exception to whatever “rule” is in place. I justified drinking more over a weekend than the weekly recommended amount by the age-old saw “everyone is doing it” (despite the fact that I am always telling my pre-teen that this is not a reason for doing anything at all ….).

One of the most surprising conclusions I found when I examined life after turning 40 was just how boring it was to be in the continuous habit of drinking wine to excess on a Friday, Saturday and Sunday night. Both literally and metaphorically, mind-numbingly, boring! It’s also not conducive to following complex narrative box-sets like Game of Thrones or House of Cards – which really should, by law, only be watched first thing in the morning, armed with a notebook, a bullet coffee and a Rolodex of character names and sub-plots…

As I aged, I also found the physical effects of excess booze to be increasingly unpleasant. Even two glasses (although two glasses can be a good half a bottle!) left me crotchety and (even more than usually) impatient with my kids. My sleep was really badly affected. Waking dry-mouthed and thirsty with a thumping head at 2am isn’t much of a trade-off for passing out the minute your head hits the pillow. On a pure vanity basis, I hated what my sister and I called “wine-face” (a kind of puffy, small-eyed look that was nobody’s friend, especially post 40).

Like so many people though, I couldn’t imagine what life without alcohol would look like. It seemed impossible to even consider. What would other people think? They’d think I was an alcoholic wouldn’t they? How could I socialise with friends? (My memories of nights out when pregnant and not drinking were of boredom and resentment that everyone else could get wasted). How would I relax? How could I even consider going on holiday?

I didn’t know a single person in my circle of friends who didn’t drink (cf Irish, parents, mid-40s). Then I came across on Facebook a blog https://lifeafteralcohol.com/ written by an Australian woman with a very similar background to me – young children, lawyer, interest in writing and so on. She described how she had stopped drinking – and her life had improved. It wasn’t easy, she wasn’t outlining a sudden transformation to the life of her dreams. But lots of things got much, much better for her.

This opened the floodgates (because of course that’s how the whole internet rabbit-hole works) to a whole world of blogs out there, written by many wonderful men and women who have chosen to live without alcohol. For me, this seemed to be the trigger I needed to realise that it WOULD be possible to live a happy, sociable life without drinking more wine than I wanted to, week in and week out.

One of the biggest resources I found was Belle and her blog http://tiredofthinkingaboutdrinking.com/. Belle is pretty much the Ariana Huffington of the alcohol-free world (of course she’s much too modest I’m sure to accept that comparison). Her 100 day challenge gets thousands of people on the road to a life without alcohol. One of Belle’s biggest themes is just how exhausting it is to be thinking about alcohol all the time (if you are a person who drinks more than they want to). Thus her blog title.

Armed with a hundred personal stories from the blogosphere, I made the decision in June 2014 to abstain from alcohol. I made the decision on a Monday and decided to stop that coming Sunday as I had a very large event to attend on the Saturday. I had no alcohol until that Saturday – and didn’t even cane it on that night. That morning, flying back to London I felt relief to know that for the next 100 days at least I wouldn’t have any booze whatsoever. In the very back of my mind though, was the hope and determination that it wouldn’t be 100 days, but “forever”. Rather than scaring the bejesus out of me, that thought filled me with joy and optimism, for a life that wouldn’t be wasted in the endless cycle of booze-fog and regret.

If you’ve found this article in any way useful or have any questions, please let me know! This is my first foray into writing and I would love to have your feedback.

I am planning to write the next article about what it was like when I first stopped – what was hard, what helped me – and most importantly, what life is like now, nearly two years on.

For anyone struggling with alcohol or who would just like to explore the possibility of life without the boring booze, I’ve listed some blogs and resources that were useful for me. Are there any others you would recommend?

And now over to the full Christopher Walken big beat boutique jive delight …..

PS You might want to watch this on Sunday night – BBC2 9pm

Louis Theroux: Drinking To Oblivion
Louis Theroux spends time at King’s College Hospital in London, a specialist liver centre, where he immerses himself in the lives of patients in the grips of alcohol addiction and the medical staff trying to make them better.
Edited to add: 23rd April 2016
Louis Theroux’s ‘Drinking To Oblivion’ Reveals The Terrifying Reality Of Alcohol Abuse

Lancet psychiatry: Articles on young people and substance use

the lancetWithin the UK there are two hallowed publications within medicine –  the British Medical Journal (BMJ) and The Lancet.  This series was published within The Lancet Psychiatry in February.  The fact that it was a series of research publications indicates how serious an issue substance misuse within young people is.

Here are the links to the full series of publications which are all freely available once you have registered your email with the journal.

February 18, 2016
Why young people’s substance use matters for global health
Wayne D Hall, George Patton, Emily Stockings, Megan Weier, Michael Lynskey, Katherine I Morley, Louisa Degenhardt
 
The increasing global health priority of substance use in young people
Louisa Degenhardt, Emily Stockings, George Patton, Wayne D Hall, Michael Lynskey
 
Editorial
Drug policy: getting over the 20th century
The Lancet Psychiatry
 
Prevention, early intervention, harm reduction, and treatment of substance use in young people
Emily Stockings, Wayne D Hall, Michael Lynskey, Katherine I Morley, Nicola Reavley, John Strang, George Patton, Louisa Degenhardt
 
This is the summary for the above article:

We did a systematic review of reviews with evidence on the effectiveness of prevention, early intervention, harm reduction, and treatment of problem use in young people for tobacco, alcohol, and illicit drugs (eg, cannabis, opioids, amphetamines, or cocaine). Taxation, public consumption bans, advertising restrictions, and minimum legal age are effective measures to reduce alcohol and tobacco use, but are not available to target illicit drugs. Interpretation of the available evidence for school-based prevention is affected by methodological issues; interventions that incorporate skills training are more likely to be effective than information provision—which is ineffective. Social norms and brief interventions to reduce substance use in young people do not have strong evidence of effectiveness. Roadside drug testing and interventions to reduce injection-related harms have a moderate-to-large effect, but additional research with young people is needed. Scarce availability of research on interventions for problematic substance use in young people indicates the need to test interventions that are effective with adults in young people. Existing evidence is from high-income countries, with uncertain applicability in other countries and cultures and in subpopulations differing in sex, age, and risk status. Concerted efforts are needed to increase the evidence base on interventions that aim to reduce the high burden of substance use in young people.

As a nurse who is training to be a child and adolescent psychotherapeutic counsellor and who has a special interest in substance misuse and desire to work with this vulnerable client group because of my own history I feel this is a really really important topic.  Many local NHS services do not have a specialist child and adolescent substance misuse service (CASUS) which is true for my county here in Suffolk but I know there is one in our neighbouring county Cambridgeshire.  I hope that Liam Byrne’s work within Parliament will start the process to help change that ……

7 Things That Happen When You’re The Child Of An Alcoholic

adult child of alcoholics characteristicsThis was on BuzzFeed in February sharing the experience of being the adult child of an alcoholic.

My dad was an alcoholic.

Not the suave chain-smoker who drinks whiskey from die-cut glasses, nor the sardonic barfly in khaki trousers whom everybody keeps around because they’re just so loveable.

My dad was the kind of alcoholic who fell over in the street, kicked down the front door, and woke the neighbours. He was the kind of alcoholic who hid his cheap beer in the bedside cabinet. If you passed him in the street, you’d have seen a drunk. He had a job, a wife, and five children. I’m one of them.

1. Nobody believes you.

The image of Ireland being a nation of pissheads is largely a stereotype. But it’s true that we do like a drink. Everyone we grew up with drank, and we mostly saw them in situations where drink was plentiful – weddings, funerals, Christmas. Everyone was pissed – including my dad.

He also held down a job. Every morning his alarm would wake us up, followed by the “pssst” of a can being opened (a sound that still freezes my heart, years later). He’d drink in bed, then brush his teeth, get on his bike, and cycle to work. When we bumped into his colleagues, they talked about how funny and friendly he was.

So nobody believed that my dad would be pissed before we turned up at whatever social occasion. And his minty-fresh breath hid the sour, apple-y edge of alcohol. Everyone has one too many and kicks a door in occasionally. Don’t they?

2. You don’t believe yourself.

I don’t blame anybody for not believing us. They didn’t see the worst times. But even seeing isn’t believing. Even when you’re there, cowed under drunken rages, binning cans, helping getting the younger ones ready for school while your dad drinks a beer, part of you doubts it’s really happening. We’d beg our dad to stop drinking and he’d respond by telling us he barely drank – while slurring, with a can in his hand. He’d occasionally say he was an alcoholic and I’d internally hope it was a confession, a turning point. But living with an alcoholic is life within a hall of mirrors, of warped reflections and dead ends. It was no confession – just an excuse for why he could continue drinking. He was an alcoholic, so he drank.

It becomes tediously, painfully normal. You go to school, you see your friends, your dad is drunk, you come home, you have your dinner, your dad is drunk, there’s a massive fight, you go to bed, you lie awake, the staircase creaks, your dad is drunk. Life goes on, and nothing changes. I started to second-guess every emotion I had – every time I cried or felt sad, I told myself I had no reason to cry or be sad. That maybe if I didn’t cry and if I wasn’t sad, he wouldn’t drink. It wasn’t that bad.

3. The best and worst of times are often one and the same.

There were nights my dad would wheel his bike into the house (when he could still cycle) and hanging off the handlebars with a four-pack of beers would be a takeaway for everyone. We’d scatter across the living-room floor watching TV, eating chips, and chatting, just like a normal family. Sometimes he’d cook a steak, avalanche it in pepper, then cut bits off it and give us a piece each with a slice of bread. I cherish the memories of those nights.

Throughout Christmas 2005, he stayed sober and it was wonderful. He was the man we knew was buried beneath the booze – the sarcastic man who had a riposte for everything, the sweet man who leaned against the fireplace with a half smile as you opened your presents (in the years before, he’d have hidden them, with gymnastic squirrelling, in eaves and cupboards you didn’t even notice, let alone could reach), the silly man who always wore the paper hat from the cracker, and the shy man who didn’t want you to take a picture of him wearing it. He’d had days off the drink before, but we hoped this would be the last time, the time it was forever. We had hoped before, but we still hoped.

When it was time for me to leave for my flight, my dad said he’d come and get the taxi with me. I hadn’t had any time alone with him over Christmas so I was happy to have him to myself. We had five minutes before he kissed my cheek hastily, then abruptly got out of the taxi. He crossed the road to the off-licence without turning back. I waved goodbye from the window.

4. It’s not always OK.

That was the last time I saw my dad outside of hospital. He died five months later, on 17 May 2006, at the age of 47. Even now, nearly a decade later, I still think he’s just “somewhere else”. In my dreams he appears in the strangest of places – a caravan on a petrol station forecourt, at the window of a childhood home. Because despite everything, I never believed he would die. In everything I’d ever read or watched (and I hungrily consumed anything I could find about addiction), they were always OK. You’d turn the book over and there they were on the back cover, golden, smiling, and healthy. And I believed, until the end, that’s what would happen to him, too.

But it didn’t.

5. You become jealous of strange things.

Losing any parent is devastating. But I feel a stab of envy for people whose parents die of an illness or of natural causes. Because they have years of memories where the person they loved wasn’t ill, and because they died of something other people can empathise with.

One of the first times I broke down after my dad’s death was while watching an advert about cancer. A bride turns to the camera and says, “I wish my mum was here.” I sobbed and took my tears on to a bus and sobbed there, and then carried them into the work toilets, where I shut the door and sobbed there, too. Because my dad wasn’t going to be at my wedding, or meet my children, or ever again pick up the phone and then pass it to my mum. He wasn’t going to be there, and nobody cared that he wasn’t. There were no adverts about us, no Races for Life, no rattling collection tins. No one fought for him – he was refused a liver transplant, so nobody even tried to save him. There was nothing but condemnation, disdain, and ridicule for people like him, and few shoulders and little sympathy for people like us. People like my dad were heckled on Jeremy Kyle, not held in hushed memorial.

You probably hate me for saying that, and I hate myself for it. No death is easy, no illness is kind. And cancer is brutal, horrific, ugly, and soul-destroying. I hated him, too, for dying in a way that locked us in our grief, that meant we couldn’t even reach out to an awkward shoulder for fear of being blamed, for collapsing under the weight of shame that we couldn’t save the one we loved, with our love.

It’s hard to know what to say when someone dies. It’s hard to write the obituary, to comfort the loved ones, to retell the stories faithfully. In our case, there weren’t any phrases like “he lost his battle” or “he fought hard” – but he did.

6. You develop a strange attitude to alcohol.

You’d think that after seeing alcohol destroy my dad’s life, I’d be a preachy teetotaller. Sometimes I am. When I’m not drinking, I hate being around people who are. I feel panicky when I hear a can open, I feel disgust when someone slurs a gust of booze into my face. I try to avoid hanging out with people I know are heavy drinkers (and I’m pretty good at “spot the alcoholic”).

But sometimes I see people with a beer and they’re laughing and relaxed and happy. And I so violently want to be normal, to be someone other than the girl whose dad died of alcoholism. I’m searching for that ease – of the steak nights, of the takeaways – so I have a beer, hoping to find it. I want to prove that I’m just like everyone else.

But I’m not – I’m my father’s daughter. I find it hard to stop once I’ve started. The ease doesn’t come, because it didn’t come from the beer in the first place. So in the past, I have swung from puritan to pisshead – sometimes within the space of an evening.

7. You’ll live through this.

I have a baby. He’s tiny, beautiful, and hilarious. When I look at him, I can see the ears I inherited from my dad, and our untameable Northern Irish hair. There have been times I’ve held him and wondered how our dad could leave us.

But most of the time, I understand that he didn’t leave us willingly. From the depths of grief it can be hard to see the way out. As the years have passed, I have been able to remember more of the joyful times too. They are the same ones I share with my son – reading a book, chasing each other around around the floor laughing, singing Bowie songs.

I see my son and realise that, just like when I have feelings of sadness that are nothing to do with him, so my dad’s feelings were independent of us all. It was out of our control, and it always was. We didn’t cause it, we couldn’t change it. In his case, it had tragic consequences, but it doesn’t doom us to following the same path.

My siblings are some of the most compassionate people I know. After everything we’ve been through, what we’ve learned is that everyone can struggle – you can have a family, a job, all the trappings of a normal life, and still struggle. That you should try to be kind to everyone, to see them in their entirety and not just as whatever they’re struggling with. To not give into judgements. That happy moments exist, even within the sad times, and that you can be OK, and when you’re not, you are still worth being loved. These are the lessons I want to pass on to my son – that the ease is from inside, and that you are perfect and loveable as you are.

Strangers may have passed my dad and seen a drunk. But he was also the Python devotee and Bowie fanatic who taught us all how to read, bought us our first microscopes, was proud of everything we did, and who photographed the oddest minutes of our lives so now we have a path back to those joyful minutes, to remember and to honour them, and to repeat them.

Thank you for putting into words much of my experience too.

If you’d like to meet like minded people you could always try an Alateen meeting as described here on Newsbeat recently:

Inside an anonymous support group for the children of alcoholics

Alcohol-free: why temperance drinks are making a comeback

temperance drinksThis was an excellent piece in The Guardian word of mouth blog as Lent started in mid February – another excuse to give your liver a rest if you need to 😉

Booze. We’re so over it now. Not only is the government trying to wean us off our swift halves with its new alcohol guidelines (so good luck with that, then), but there’s been shocking exposure of “Britain on the Booze”, and a “dramatic rise” in the number of young teetotallers shunning their alcopops and Bacardi Breezers.

Add Lent to the cocktail and the self-righteous whiff of abstinence is definitely in the air, so what better time to stock up on your temperance drinks? The Temperance movement started in the early 19th century, mostly in the industrial north, as an antidote to the voracious boozing of the day – and, allegedly, to sober up the workforce.

I have always been a lover of these old-style botanical brews: the sweet furriness of cream soda, the aniseedy kick of dandelion and burdock, the medicinal-smelling sarsaparilla that tastes ever so faintly of toothpaste. For one thing, they have a depth of flavour you don’t normally find in soft drinks, although, apparently, Coco-Cola and Vimto started life as temperance beverages.

Then there’s the scent of bubbling oranges filling the kitchen with a knuckle of ginger, a pan of stewing blackberries, sticky and sweet. I like the names too: black beer and raisin, rhubarb and rosehip, blood tonic.

Temperance drinks were big in aromatics, so if you want to make your own, stock up on your spices and extracts; cloves, nettle, cardamom seeds, liquorice, essential oils. For a glimpse of the real thing, head to Fitzpatrick’s in Rawtenstall, Lancashire, thought to be the last temperance bar in the UK and founded in 1890. Here, herbal brews were supped for their reputed medicinal benefits too (lemon and ginger for the immune system, for example, nettles for the kidneys. But let’s not even mention the sugar). If foraging is your thing, tug on your wellies and don’t be afraid to dig (although do get the permission of the landowner).

For dandelion and burdock, look out for burdock’s large, furry, heart-shaped leaves and boil with dandelion roots sweetened with sugar, two spoonfuls of black treacle and lemon juice. Many temperance cordials use syrup as a fruity base. Try this simplified peach syrup from Bertha Stockbridge’s 1920 prohibition classic “What to Drink”: simmer 10oz of peach slices with 8oz of water and 8oz of sugar for 30 minutes, then strain. From there on, the world of flower power opens up. Don’t be afraid to experiment. The Anthologist in London does a whole range of cheeky tipples made from its homemade syrups and infusions, which you can make from pretty much anything: vegetables, herbs, even meat. (It even does a bacon-infused, non-alcoholic bloody mary.)

Beware of making them too sweet, however – a common mistake, according to the great mixologist Tony Conigliaro. So combine the lemony-tartness of hibiscus with zingy raspberry puree. Purists can check out the original 1904 “Recipes for Temperance Drinks”, which includes gingerette, peppermint cordiale and Boston cream, although I think I’ll pass on Mrs Hibbert’s Temperance Brandy, which is basically cinnamon powder dissolved in a wineglass of hot water.

Mostly, I like to keep it simple: hot Luscombe ginger beer with a splash of grenadine and a squeeze of lime juice. One of the tastiest temperance drinks I have ever had was a violet and jasmine crush at The Botanist in Leeds, the blend of mint, violet and jasmine syrup with lime juice, apple juice and soda water was like a mouthful of honeyed sunshine. Who needs gin?

Loved this!  And the sub header: “compared with more modern soft drinks, traditional botanical brews may be old-fashioned, but they are packed with flavour and anything but boring”  If you do feel like a a botanical non-alcoholic brew with a whiff of gin about it – may I recommend Seedlip? 😉

Postscript: 10am This time 5 years ago I was about 5 miles into running the London Marathon!!  For me preparing for that event in my life was where this journey all started …..