Daily Archives: 29/01/2016

Friday Sober Jukebox – Oddity

david bowieIt seems only right to have a sober jukebox dedicated to the late great David Bowie who had been in recovery since the late 70’s following being given custody for his son.  The track, Space Oddity, is both my favourite of his and also speaks to the disconnect in opinions about the value of Dry January campaigns.  And as we head into the last days of the campaign it seems a good time to reflect.

Here is the BMJ’s Head to Head take on it:

Could campaigns like Dry January do more harm than good?

Lack of evidence that such campaigns work and don’t have unintended consequences, concerns Ian Hamilton. But Ian Gilmore thinks they are likely to help people at least reflect on their drinking

Yes—Ian Hamilton

Two questions should be asked of any public health message about alcohol: is it evidence based and who is the target audience? Now in its fourth year, the Dry January campaign, which uses peer pressure to encourage abstinence from alcohol for the month, is promoted by the charity Alcohol Concern in England and Wales.1 It is supported by Public Health England so in effect has government approval. The campaign estimates that “Last year over 2 million people cut down their drinking for January.”1

But popular doesn’t necessarily mean effective. Alcohol Concern’s ambition is to alter people’s relationship with alcohol by encouraging us to reduce the amount we drink, not just for a month but for life. Unfortunately, this type of campaign has had no rigorous evaluation.

Self selecting participants

It is not clear who Dry January is targeting. Because participants select themselves it could attract the people at lowest risk from health problems related to alcohol. Because they consume less alcohol they are also likely to find a month of abstinence relatively easy, as a recent study indicates.2 The campaign should offer a range of advice and more carefully tailor these messages to match the individual’s use of alcohol.3 For example, one high risk group is people aged over 65. Trying to communicate a message about alcohol to the over 65s at the same time as the under 25s risks the message not being heard, as the way these groups use alcohol is likely to be different.

Many of us can be economical with the truth when it comes to how much we drink. Research comparing self reported alcohol consumption with total alcohol sold found a large disparity.4 It is not clear whether this mass denial affects Dry January. At the very least an appraisal of how much and how often an individual really drinks will influence whether they see a need to test their ability to go without alcohol for a month or simply view the campaign as more nagging and switch off. If people aren’t honest with themselves about their drinking, how can Dry January help?

All or nothing

Dry January also risks sending out a binary, all or nothing, message about alcohol—that is, either participate by abstaining or carry on as you are. Dry January could be adding to the confusion we know exists in communicating messages about alcohol—for example, in public health advice about safe levels of alcohol consumption using recommended maximum daily or weekly units of alcohol. Health professionals lack understanding about units.5 Beyond the problems of misinterpreting the guidance, the advice depends on people keeping a tally of the number of units they consume; only 13% do this.6

Dry January has the potential to compound this muddle. Although not the intention, people may view their 31 days of abstinence as permission to return to hazardous levels of consumption till next New Year’s day. “I’ve had a month off, so now I can drink as much as I did before, ignoring the need for regular breaks from alcohol.”

Heavy drinkers

Most people can stop using alcohol without any immediate harm. However, for some heavy drinkers or people who have experienced withdrawal previously, abrupt abstention from alcohol can induce serious symptoms such as seizures.7 This is not a group of people who should be participating in a do-it-yourself detox such as Dry January. They will need expert help and a supervised detoxification programme to ensure their withdrawal from alcohol is managed safely. If Dry January’s campaign material made this clearer it would go some way to minimise potential harm. Otherwise, the campaign risks setting up dependent drinkers to fail, compounding their inability to gain control of their drinking. We don’t know what effect the additional attention given to alcohol through the promotional activity of Dry January has on this group.

In sum, parched of evidence Dry January could have unintended consequences which would do more harm than good.

No—Ian Gilmore

Although successive Westminster governments may have difficulty in acknowledging the scale and scope of alcohol related harm in the United Kingdom, few readers of The BMJ will fail to make the connection in their daily work (and play) between our increasingly uneasy relationship with our favourite drug and the burden on the NHS and emergency services and harm to others.

Our per capita consumption has doubled over 40 years, we have 1.5 million heavily dependent drinkers in this country, and alcohol has become a central part of most social occasions.6 So what could possibly be wrong with encouraging and supporting the estimated two million or so adults who decide on Dry January8—to take a month off the booze and have time to reflect on their drinking?

Sustained drop in drinking

Maybe it is the “nanny state” and interference with personal choice? Well, it is just a personal choice to take part in this voluntary event instigated by the charity Alcohol Concern, which receives no direct government funding. There has been some support in kind from Public Health England, and its independent evaluation of 2015’s Dry January showed that 67% of participants said they had had a sustained drop in their drinking six months on.8 In an earlier evaluation by the University of Sussex, 79% of participants said they saved money, 62% of participants said they slept better and had more energy, and 49% said they lost weight.9

Indeed, researchers at London’s Royal Free Hospital showed that one month’s abstinence produced quite remarkable changes in such diverse aspects as blood pressure, liver stiffness, γ glutamyltransferase concentrations, insulin resistance, and body mass index.10

Greater wellbeing, better sleep

More studies are needed to see how sustainable some of these benefits are, but the overwhelming experience of those participating is greater wellbeing, better sleep, and a sense of achievement. That and the relief that they are not as dependent on that regular “anxiolytic agent” as they thought; there is a life out there that does not have to revolve around drinking.

There are no “prohibition” or “temperance movement” agendas here, and the majority of people choose to return to drinking, although 8% of those followed up by Public Health England six months later had decided to capitalise on the benefits and stay dry.8

The campaign is aimed at social not dependent drinkers, and heavy drinkers are recommended to see their general practitioner before stopping suddenly and completely. But each year Dry January brings to light some dependent drinkers who need professional help, and services for them are still patchy and inadequate.11 But it can’t be bad that some of the 1.5 million dependent drinkers in this country make the first steps towards help.

Some myths around Dry January need to be addressed. It should not be treated as a money raising sponsoring opportunity, culminating in drunken celebration at the month’s end, nor as an excuse for thinking “job done; body detoxed; I can go straight back to the old ways for the rest of the year.” But evaluations indicate that campaigns like Dry January are being used more as a way of people examining their relationship with alcohol and making longer term changes. Further study is needed, not just of the 50 000 people who sign up with Alcohol Concern1 and get support but also the estimated two million people who simply decide to quit the booze after the Christmas break for a month.

Release of the UK chief medical officers’ guidelines on drinking is timely, with their emphasis on having several alcohol-free days each week—some “dry weekdays.”12 Although it is unlikely that this will have much impact on health measures such as blood pressure and insulin resistance, it should be a focus for further research. Until we know of something better, let’s support growing grassroots movements like Dry January and Dry July in Australia and take a month off.

BMJ 2016;352:i143 (references on link page)

I completely agree with Sir Ian Gilmore as it was that month off and having a chance to reflect on my drinking that started the ball rolling to me stopping for longer.  What are your thoughts?

OK so over to Mr Bowie:

Tommy Rosen 2016PS – Tommy’s 2.0 Recovery Conference is back!
http://recovery2point0conference.com/

 

What alcohol does to your body after the age of 40

This was in The Telegraph in December and thanks to Laura over at Club Soda for bringing it to my attention!  As someone now closer to 50 than 40 it resonated strongly …..

over 40If you’re over 40 and live in Britain, the chances are you like a drink.  As the Chief Medical Officer Dame Sally Davies considers the current NHS drinking guidelines, experts are urging us to spare a thought not only to the short-term effects of alcohol on our brains, but also to the damage our drinking habits are doing to our bodies as we approach middle age.

Alcohol affects just about every system because it’s a small molecule that goes everywhere in the body,’ says Paul Wallace, emeritus professor of public health at University College London and medical director of the charity Drinkaware.  ‘From the gut to the heart, the blood vessels to the skin, its effects are all pervasive.’  But why does it feel like the effects of drinking are so much worse post-40? ‘The organs that metabolise alcohol such as the liver and the stomach shrink as you get older, so alcohol stays in your system longer,’ says Dr Tony Rao, consultant old age psychiatrist at the South london and Maudsley NHS Foundation Trust. This could explain that wretched two-day hangover post-40.  ‘Plus, the total fluid in the body is a lot less – we get more dehydrated as we get older – so because alcohol is distributed in blood which will be more concentrated, it won’t be broken down as quickly as it would in the bloodstream of a 20 year old.’  

Here’s what else alcohol is doing to your body post-40.

Brain

‘Alcohol gets through the blood-brain barrier where it works as a depressant,’ says Professor Wallace. ‘We feel quite excited and stimulated when we drink because it’s having a depressing effect on controlling behaviours such as judgement, self-monitoring, planning and reasoning’, he says. It explains why what seemed like great idea the night before is not so much the morning after. ‘Over time this gives you a higher propensity to mood problems such as anxiety and depression.’  In his NHS clinic specialising in alcohol problems, Dr Rao sees people in their 60s with subtle alcohol related brain damage after a lifetime of casual drinking. ‘I always say to my patients ‘Your brain is affected a lot earlier than your liver’’, he says. ‘Before we see the cirrhosis we see depression and problems with impulse control, moodiness, problems making complex decisions, say with finances and their children or spouses might say ‘Oh that’s just so-and-so being a silly old bugger,’ so the problems are missed.’  Good news is, the damage can be reversed after just six months of not drinking, he says. 

Skin

Alcohol causes a flushing of the skin in those prone, says Professor Nick Lowe, consultant dermatologist and spokesperson for the British Skin Foundation. ‘This can trigger rosacea, a chronic redness in the skin because the blood vessels enlarge and produce more blood flow. Though the redness can go down, over time it can lead to a permanent enlargement of the blood vessels and visible thread veins on skin.’  These can be treated with pulsed right or vascular lasers but are better caught early for best results, he says. And those spots you get after a night out?  Here’s why. ‘Alcohol can make people stressed and anxious and this stress produces the androgen hormones that stimulate acne,’ says Professor Lowe.  And the reason heavy drinkers tend to look a little worse for wear? ‘The skin becomes dehydrated and and the fluid lost can lead to flakiness and puffiness around the eyes,’ he says. ‘Plus, the excess sugars you’re consuming – especially with beer and wine – damage the DNA and collagen in the skin which can lead to more rapid ageing.’

Heart

People who regularly binge drink – that’s classified as drinking double the daily limit of 3-4 units for a man and 2-3 for a woman or more in one session – dramatically increase their risk of stroke, says Professor Wallace. Drinking raises blood pressure both short and long term which increases heart attack and stroke risk. Excessive alcohol also damages the heart’s ability to pump, a condition called cardiomyopathy which increases risk of heart failure, says Dr Mike Knapton, associate medical director of the British Heart Foundation. But surely a glass of red wine a night is good for the heart? Knapton concedes that research does confirm this, ’but the benefits come from less than one glass of red wine a day, so the first glass might do you good but anymore won’t.’

 Liver

Liver disease has risen in the UK by a staggering 400 per cent since the 1970s. ‘Those at risk are not just chronic alcohol abusers, but also middle-aged, professionals who drink a little too much most nights,’ says Dr Debbie Shawcross, consultant hepatologist at King’s College Hospital Liver Unit. ‘The liver may start out a little fatty and then if you continue heavily drinking between say 40 and 55 the fat and inflammation creates scar tissue and the liver shrinks and – for about one in six people -can lead to cirrhosis or liver disease.’ 

The liver has a healthy ability to heal itself and the British Liver Trust suggests aiming to have three consecutive non-drinking days a week, to give it a chance to regenerate – they also have an iPhone app called Spruce that helps you work alcohol free days into your week.

 Cancer risk

 Each year about 13,000 cases of cancer in the UK are attributed to alcohol consumption. ‘In terms of cancer risk, there is no safe level of drinking,’ says Nicola Smith, health information officer for Cancer Research UK.  ‘The cancers most closely linked to alcohol consumption are those of the mouth, oesophagus, bowel, breast and throat,’ she explains.  The more you drink, the higher your risk because ethanol in alcohol is broken down into acetaldehyde which damages DNA and directly impacts cells that cause cancer.  Plus, ‘If you’re smoking and drinking at the same time, you’re increasing your risk of mouth and throat cancer because alcohol makes cells more responsive to the toxins in tobacco smoke,’ she says. This effect is even in casual drinker/smokers, she asserts.

Fertility

A pioneering Danish study of thousands of couples who had discontinued contraception in order to conceive found that tee-totallers got pregnant much sooner than even very light ‘social’ drinkers and they had a lower miscarriage rate. Even where couples resort to IVF, a US study found that moderate drinking (half a bottle of wine a week) was associated with an 18 per reduction in success rates for women. ‘For men, excessive alcohol consumption lowers testosterone levels and reduces sperm quality and quantity,’  says Dr Gillian Lockwood, fertility specialist and medical director of Midland Fertility. The ‘sperm cycle’ is 70 days, so the damaging effect of a serious binge may take a couple of months to improve, a more serious consideration for men over 40 whose sperm is already declining in quality’.

Weight

Alcohol contains seven calories per gram, nearly the same as fat (9 calories per gram) and when you drink the body recognises its by-products as toxins and chooses to break these down first over the nutrients in food, explains nutritionist Robert Hobson, co-author of The Detox Kitchen Bible (Bloomsbury £14.99).  ‘ When the body gets round to metabolising the food, it may no longer require the calories, so they get stored as fat.’  Studies also show that drinking can suppress the hormone leptin, which controls appetite which is why people can over eat when drinking. As a sugar source, alcohol raises insulin and turns on fat storage by increasing fatty deposits in the liver and , in middle age, excess can lead to fat storage around the stomach –  a root cause of the classic ‘beer belly’.

Laura & I will be running our next How to Quit Drinking workshop in 2 days if you’d like to join us? 🙂