Category Archives: Physical

Drinking in pregnancy: where next for preventing FASD in the UK?

My son was conceived on a Bank Holiday August week-end.  Ironically I also attended a Hen Do that week-end where as you can guess much alcohol was consumed despite my trying to conceive at the same time.  So this post today seems fitting.  It is courtesy of a guest blog for Alcohol Policy UK that I read in May called Drinking in pregnancy: where next for preventing Fetal Alcohol Spectrum Disorders (FASD) in the UK?

In this guest blog, Kate Fleming, Senior Lecturer, Public Health Institute, Liverpool John Moores University, and Raja Mukherjee, Consultant Psychiatrist, Lead Clinician UK National FASD clinic, Surrey and Borders Partnership NHS Foundation Trust consider the context and future for Fetal Alcohol Spectrum Disorders in the UK.

A recent opinion piece in The Guardian entitled Nothing prepared me for pregnancy- apart from the never ending hangover of my 20s took a, presumably, humorous take on the tiredness, vomiting, dehydration, and secrecy that so many women live through in early pregnancy, likening this to days spent hungover after excessive drinking in the author’s early 20s.

In an article that was entirely about alcohol and pregnancy there was reassuringly no mention of the author consuming alcohol during pregnancy, indeed quite the reverse “I don’t actually want booze in my body”.  But neither was there explicit reference to the harms that alcohol can cause in pregnancy. 

The harms caused by consuming alcohol in pregnancy

Fetal Alcohol Spectrum Disorders (FASD) is an umbrella term that encompasses the broad range of conditions that are related to maternal alcohol consumption.  The most severe end of the spectrum is Fetal Alcohol Syndrome (FAS) associated with distinct facial characteristics, growth restriction and permanent brain damage.  However, the spectrum includes conditions displaying mental, behavioural and physical effects on a child which can be difficult to diagnose.  Confusingly, these conditions also go under several other names including Neuro-developmental Disorder associated with Prenatal Alcohol Exposure (ND-PAE) the preferred term by the American Psychiatric Association’s fifth version of its Diagnostic and Statistical Manual (APA DSM-V), alcohol-related birth defects, alcohol-related neuro-developmental disorder, and partial fetal alcohol syndrome.

How common is FASD?

A recent study which brought together information from over 300 studies estimates the prevalence of drinking in pregnancy to be close to 10%, and around 1 in 4 women in Europe drinking during pregnancy. Their estimates of FAS (the most severe end of the spectrum) were 14.6 per 10000 people worldwide or 37.4 per 10000 people in Europe, corresponding to 1 child in every 67 women who drank being born with FAS. 

Given the figure for alcohol consumption in pregnancy is even higher in the UK, with some studies suggesting up to 75% of women drink at some point in their pregnancy, conservatively in the UK we might expect a prevalence of FASD of at least 1%.  We also know that it is highly unlikely that anything close to this number of individuals have formally had a diagnosis.  This lack of knowledge of the prevalence in the UK is hampering efforts to ensure the required multi-sector support for those affected by FASD and their families.  

Current policy

For some time a significant focus of alcohol in pregnancy research was to try and identify a safe threshold of consumption, without demonstrable success.  No evidence of harm at low levels does not however equate to evidence of no harm and as such in 2016 the Chief Medical Officer revised guidance on alcohol consumption in pregnancy to recommend that women should avoid alcohol when trying to conceive or when pregnant.  Though this clarity of guidelines has been well received by the overwhelming majority of health professionals there are barriers to its implementation with few professionals “very prepared to deal with the subject”.  In addition, knowledge of the guideline amongst the general public has yet to be evaluated.    

As part of the 2011 public health responsibility deal a commitment to 80% of products having labels which include warnings about drinking when pregnant forms part of the alcohol pledges. A study in 2014 showed that 90% of all labels did indeed include this information. However, it has also been shown that this form of education is amongst the least effective in terms of alcohol interventions, and the pledge is no longer in effect.

Pregnancy is recognised as a good time for the initiation of behaviour change yet in the context of alcohol consumption it is arguably too late. An estimated half of all pregnancies are unplanned and there remains therefore a window of early pregnancy before a woman is likely to have had contact with a health professional and before the guidelines can be explained during which unintentional damage to her unborn baby could occur.  The same argument can be used when considering the suggestion of banning the sale of alcohol to pregnant women – visible identification of pregnancy tends only to be possible at the very latest stages.

How then to address consumption of alcohol during pregnancy? 

Consumption of alcohol is doubtless shaped by the culture and context of the society in which one is living.  Highest levels of alcohol consumption in pregnancy are, unsurprisingly, seen in countries where the population consumption of alcohol is also highest.  Current UK policy that is directed to reducing population consumption of alcohol will likely have a knock-on effect of reducing alcohol consumption in pregnancy.

Many women will however be familiar with the barrage of questions that they encounter when not drinking on a night out.  From the not-so-subtle “Not drinking, eh… Wonder why that is? <nudge, nudge, wink, wink>” to the more overt “Are you pregnant?”.  The road to conception and pregnancy is littered with enough stumbling blocks and pressures that the additional unintentional announcement of either fact of conception or intention to conceive is an unnecessary cause of potential further anxiety. Until society accepts that not drinking is an acceptable choice, without any need for clarification or explanation, then pregnant women or those hoping to conceive who are adhering to guidelines will continue to identify themselves, perhaps before they want to. 

What next?

The UK’s All Party Parliamentary Group for FASD had its inaugural meeting in June 2015.  This group calls for an increased awareness of FASD particularly regarding looked after children and individuals within the criminal justice system, sectors where the prevalence of FASD is particularly high. Concerted efforts need to be made to identify children with FASD to ensure that the appropriate support pathways are in place. Alongside this, efforts to ensure the best mechanisms for education of the dangers of alcohol consumption in pregnancy need to be increased, including training for midwives, and other health professionals who may be able to offer brief intervention and advice to women both before and after conception.

NOFAS run a national FASD helpline on on 020 8458 5951 as do the FASD Trust on 01608 811 599.

Liver Transplantation

So I realised when I read this news story that I hadn’t actually ever detailed the liver and transplantation on the blog!  As reported by Alcohol Policy UK earlier this month: Liver transplants have been highlighted by an Eastenders storyline featuring Phil Mitchell (pictured as played by Steve McFadden) suffering with alcohol-related liver disease, reported the Express. The storyline has been praised by Sally Johnson, Director of Organ Donation and Transplantation for NHS Blood and Transplant, who said it had been portrayed responsibly. The Express followed up with the article Liver disease warning: How much damage are YOU doing to your vital organ?

So firstly lets look at how important the liver is and what function within the body it serves.

Your liver has around 500 different functions.  Importantly it:
  • fights infections and disease (which is why I struggled more with illness when I drank)
  • destroys and deals with poisons and drugs (which alcohol is)
  • filters and cleans the blood
  • controls the amount of cholesterol
  • produces and maintains the balance of hormones (hence why women get an increase in breast cancer rates with drinking and men get gynaecomastia, otherwise known as “man boobs” or “moobs”)
  • produces chemicals – enzymes and other proteins – responsible for most of the chemical reactions in the body, for example , blood clotting and repairing tissue (which is why wound healing is slower)
  • processes food once it has been digested (hence why alcoholics are very often severely malnourished)
  • produces bile to help break down food in the gut (and why jaundice is an early sign of liver distress)
  • stores energy that can be used rapidly when the body needs it most
  • stores sugars, vitamins and minerals, including iron
  • repairs damage and renews itself

So it is a major organ without which we die.

By the time you discover you need a transplant your liver might begin to fail and your quality of life may be very poor. You may have experienced the following symptoms:

  • loss of appetite
  • generally feeling unwell and being tired all the time
  • feeling sick and being sick
  • very itchy skin
  • loss of weight and muscle wasting
  • enlarged and tender liver (you may feel very tender below your right ribs)
  • increased sensitivity to alcohol and drugs (medical and recreational)
  • yellowing of the skin and whites of the eyes (jaundice)
  • swelling of the lower abdomen, or tummy (ascites), or the legs (peripheral oedema)
  • fever with high temperatures and shivers, often caused by an infection
  • vomiting blood
  • dark black tarry stools (faeces) or pale stools, associated with cholestatic disease
  • periods of mental confusion.

What is a liver transplant?

A liver transplant is an operation where your diseased liver is removed and replaced with a healthy donor human liver. Although liver transplants are now quite common, the operation is not undertaken lightly. It is a major operation and the body will always see the ‘new’ liver as a foreign agent and will try to destroy it. This means that if you have a liver transplant you will have to take medication for the rest of your life to stop your body rejecting the donor liver.

If you want to read the award winning leaflet about transplantation you can do so here.
If you want to read how a liver transplant is performed go here.
You will have to abstain from alcohol for at least 6 months prior to transplantation.
You will have to take immuno-suppressant drugs for the rest of your life to stop your body rejecting the new liver and regular blood tests to monitor.  These drugs carry their own risks and side effects such as:
  • kidney damage
  • high blood pressure
  • high cholesterol
  • obesity
  • higher risk of infections

It may restrict your travel options in the future and you will carry a higher risk of skin cancer.

For further information visit: British Liver Trust

And if you want to study the liver further there is a MOOC run by the University of Birmingham you can do free online: Liver Disease: Looking after Your Liver

It is not a miracle cure or the answer to your drinking prayers.  And those alcoholics who drink after receiving a donor liver leave me feeling very conflicted indeed – and yes I have met them ……

 

NICE focuses on improving treatment and diagnosis of liver disease

I have to thank the lovely Prim for forwarding this link to me about NICE and new draft guidance on treatment and diagnosis of liver disease (cue obligatory pictures of liver disease!)

Here’s the NICE report:

People who drink too much should be sent for scans to detect early liver disease, says NICE

Almost 1.9 million harmful drinkers in England could be sent for scans for cirrhosis by their GPs to detect disease early so treatment and lifestyle changes are more effective.

A draft quality standard out for consultation advises GPs to send people for scans for cirrhosis if men are drinking more than 50 units per week or 22 pints and women are drinking more than 35 units per week or 3 ½ bottles of wine.

Access to the two recommended tests, transient elastography and acoustic radiation force impulse imaging is currently varied across England, whilst the first is available in at least 120 UK hospitals, the latter is a newer technology that is not as widespread.

Dr Andrew Fowell, consultant hepatologist at Portsmouth Hospitals NHS Trust and specialist committee member, said: “Identifying people who are at risk of liver disease and offering them non-invasive testing to diagnose cirrhosis is key to ensuring they are given the treatment and support they need early enough to prevent serious complications.”

“Ten years ago diagnosis of cirrhosis would often require a liver biopsy, but now with advances in non-invasive testing it is much easier for patients and health professionals to make a diagnosis.”

Draft guidance also calls for all those diagnosed with non-alcoholic fatty liver disease to be regularly tested for advanced liver fibrosis – so they can manage their condition and prevent it developing into cirrhosis.

Professor Gillian Leng, deputy chief executive of NICE, said: “Many people with liver disease do not show symptoms until it is too late.

“If it is tackled at an early stage, simple lifestyle changes or treatments can be enough for the liver to recover. Early diagnosis is vital, as is action to both prevent and halt the damage that drinking too much alcohol can do.

“This draft quality standard makes a number of important suggestions to improve care for those with liver disease from offering advice to less invasive testing.

NICE is calling for all adults and young people with cirrhosis to go for ultrasound scans every 6 months for hepatocellular carcinoma, in a bid to improve earlier diagnosis.

The draft quality standard also supports improvements in treatment to prevent vein bleeds in some adults and young people with cirrhosis. An estimated 2,687 people could be eligible for treatment each year.

Liver disease is the fifth largest cause of death in England and Wales. It is estimated over 4,000 people die from cirrhosis every year and 700 will need a transplant.

Consultation on the draft quality standard for liver disease is open until 2 February 2017.

I look forward to the new guidelines being published and if you are wanting to find out about liver scans prior to this please go to this blog post.

Alcohol-related cancers projected to rise – can mass media campaigns help?

cruk-university-of-sheffield-logoThis was published by Alcohol Policy UK in December regarding alcohol-related cancers.

Increasing recognition of the risks of alcohol-related cancer has been a priority for a number of health organisations, with recent research identifying limited levels of awareness and projected rises in incidences.

report released last month commissioned by Cancer Research UK (CRUK) attracted significant media coverage of its findings that alcohol-related cancers could cause around 135,000 deaths over the next 20 years in England. The modelling was carried out by Sheffield University and analysed figures under a number of consumption forecasts, and also provided updated estimates of the potential benefits of Minimum Unit Pricing (MUP). A 50 pence MUP could reduce all alcohol-attributable deaths by 7,200, including 670 cancer deaths over the next two decades, reducing alcohol-related healthcare costs by £1.3 billion.

The report follows findings released earlier in the year by CRUK stating the understanding of the link between alcohol consumption and cancer was “worryingly low”; only 13% identified cancers as a possible risk when asked to identify alcohol-related health conditions associated with drinking too much. Recognition improved when prompted with possible cancer types, but those such as breast cancer had far lower recognition than less prevalent alcohol-related cancers. See here for a CRUK alcohol and cancer page.

Data used from the report though has just been published in BMC Public Health journal revealing significantly higher awareness of the links in the North East region, where Balance North East has been conducting media campaigns including TV advertswww.reducemyrisk.tv and #7cancers Twitter activity.

Media campaigns: a question of behaviour change?

Health groups though tend not to want to see health campaigns in isolation owing to the limited impact on behaviour. Indeed similar debates have taken place with regard to the awareness of the revised drinking guidelines and the limitations of their impact on consumption.

Ealier this year Chief Medical Officer Dame Sally Davies attracted controversy for suggesting drinkers should think ‘Do I want the glass of wine or do I want to raise my own risk of breast cancer?’ each time they drink. Whether any significant number of people have taken on the CMO’s advice – or indeed deliberately rejected it – will remain unknown, but based on the evidence of the complexity of behaviour change it would seem unlikely.

As such health groups, including CRUK, not only wish to see media campaigns and improved information through mandatory labelling, but also action on price, availability and marketing. Such levers have considerably stronger evidence to support an impact on drinking behaviours, but are of course opposed by those who may support informed individual decision making but not the Government in influencing it via regulation.

As for the near future, momentum may continue with a general trend in increasing awareness of alcohol health harms. Whether this will be supported in England by legislation to ensure mandatory labelling on containers, or indeed change environmental influences, is uncertain. In the meantime, alcohol-related cancers are likely to rise before they fall, even should consumption fall further.

estimated-trends-in-annual-alcohol-attritubutable-cancer-deaths-following-reduction-in-consumptionA picture paints a thousand words ……

And edited to add this small celebratory footnote: Voted  Top 100 Addiction Blogs Winner from thousands of top Addiction blogs in Feedspot’s index using search and social metrics.  Ranked 53rd based on Google reputation and search ranking, influence and popularity on Facebook, Twitter and other social media sites, quality and consistency of posts and Feedspot’s editorial team and expert review 🙂

Back to life, back to reality … Women closing the drinking gap on men

women-closing-the-drinking-gap-on-menIt’s the end of the Christmas and New Year break and most of us head back to work or school, hence the Soul II Soul lyrics in the blog post title.  And part of that reality is that women are closing the drinking gap on men as reported by the Institute of Alcohol Studies in October 2016.  Over to their analysis:

Trend most evident among young adults, international analysis shows (25 October)

Women are catching up with men in terms of their alcohol consumption and its impact on their health, finds an analysis of the available international evidence, spanning over a century and published in the online journal BMJ Open.

This trend is most evident among young adults, the findings show. Historically, men have been far more likely than women to drink alcohol and to drink it in quantities that damage their health, with some figures suggesting up to a 12-fold difference between the sexes. But now evidence is beginning to emerge that suggests this gap is narrowing.

In a bid to quantify this trend over time, a research team pooled the data from 68 relevant international studies published between 1980 and 2014. The studies calculated male-to-female ratios for 3 broad categories of alcohol use and harms (any alcohol use, problematic alcohol use and alcohol-related harms) stratified by 5-year birth cohorts ranging from 1891 to 2001, generating 1,568 sex ratios (see above data table).

Sixteen of the studies spanned 20 or more years; five spanned 30 or more. All the studies included explicit regional or national comparisons of men’s and women’s drinking patterns across at least two time periods.

Results:

The pooled data showed that the gap between the sexes consistently narrowed across all three categories of any use, problematic use, and associated harms over time.

Men born between 1891 and 1910 were twice (2.2) as likely as their female peers to drink alcohol; but this had almost reached parity among those born between 1991 and 2000 (1.1, illustrated). The same patterns were evident for problematic use, where the gender gap fell from 3 to 1.2, and for associated harms, where the gender gap fell from 3.6 to 1.3.

After taking account of potential mathematical bias in the calculations, the gender gap fell by 3.2% with each successive five-year period of births, but was steepest among those born from 1966 onwards.

Associated health harms fall disproportionately on female drinkers

The calculation used was not designed to address whether alcohol use is falling among men or rising among women, the researchers caution.

But among the 42 studies that reported some evidence for a convergence of drinking levels between the sexes, most (n = 31) indicated that this was driven by greater use of alcohol among women, and 5% of the sex ratios were under 1, suggesting that women born after 1981 may actually be drinking more than their male peers, the researchers claimed.

Conclusions

The researchers wrote: “Findings confirm the closing male–female gap in indicators of alcohol use and related harms. The closing male–female gap is most evident among young adults, highlighting the importance of prospectively tracking young male and female cohorts as they age into their 30s, 40s and beyond.”

While they did not set out to explain the reasons behind their observed findings, they emphasised that their results “have implications for the framing and targeting of alcohol use prevention and intervention programmes.”

They concluded: “Alcohol use and alcohol use disorders have historically been viewed as a male phenomenon. The present study calls this assumption into question and suggests that young women in particular should be the target of concerted efforts to reduce the impact of substance use and related harms.

“These findings (also) highlight the importance of further tracking young male and female cohorts as they age into their 30s, 40s and beyond”, they added.

Institute of Alcohol Studies director Katherine Brown said: “The findings from this study illustrate a trend that has been in the making for decades. Women are increasingly subjected to heavily targeted marketing practices by alcohol companies enticing them to drink more. This is a global phenomenon, with drinks manufacturers producing sweet, often pink, fizzy alcoholic beverages that appeal to young women, with glamorous advertising campaigns.

“Another major driver of alcohol consumption is price, with very cheap products commonly on sale for as little as 16 pence per unit in shops and supermarkets. We are no longer a nation of pub goers, with two-thirds of all UK alcohol drunk at home. Pre-loading on cheap shop bought alcohol before a night out is common practice and police have reported strong links to crime, disorder and vulnerable behaviour in towns and city centres.

“Alcohol places a huge strain on our NHS and emergency services, with the total costs to society at £21 billion each year. We need to take this issue seriously and introduce evidence-based measures such as minimum unit pricing and marketing restrictions in order to protect out future generations and improve the health and wellbeing of our most vulnerable communities.”

Coverage from Alcohol Policy UK:

‘Women have caught up with men’ in alcohol consumption levels, headlines reported across the media. According to international research the gap between men and women is closing rapidly when it comes to use and alcohol-related harms, though in the UK men still drink more. See NHS behind the headlines analysis or BBC, The Sun and Guardian reports.

To act as a counter-balance to this view here is a recent article from the Guardian citing another BMJ study:

Female binge drinkers unfairly stigmatised by media, says study

It’s worth a read and has an interesting conclusion that begs the question: who is funding this research?

Further evidential data:

(taken from HSE 2015)

Health Survey for England 2015: latest consumption figures

Eight in 10 middle-aged Britons ‘are overweight or exercise too little’ (oh and drink too much!)

Ladies it’s the beginning of January and it’s not too late to join us for Dry January.  You can start the clock today and not become part of these statistics of the future.

Sponsored blog post: Baclofen revisited

uk-rehabSo earlier this month I was approached by AddictionHelper (also known as UK Rehab as pictured to the left) about them providing some sponsored content and they suggested the subject of Baclofen.    I have written only one post about this medication that you can read here.  And then serendipitously someone in the UK who had recently used Baclofen successfully (and will be 1 year sober on 1st January 2017) left a comment on that  blog post and wanted to speak more about their experience.  So I put the two in touch and here is the result 🙂

Baclofen: A new remedy for alcoholism?

Baclofen is a medication used in the treatment of multiple sclerosis and spinal cord injuries. Over the last decade, however, it has been put to the test in different quarters as a treatment for alcoholism.

The increase in the frequency of baclofen usage can be attributed to the fact that it has shown a proclivity for reducing withdrawal symptoms in alcoholic individuals. Presently, baclofen is still used in the treatment of alcoholism in an “off-label” manner (use outside regulatory approved boundaries).  However, trials over the last decade, point to the possible removal of the “off-label” tag.

Related studies on baclofen and alcohol relationship

Many baclofen related studies have been completed in the past. One of such studies shows that only high doses of baclofen can lead to the desired indifference towards alcohol.  Another study highlighted the relationship between the amount of alcohol consumed before treatment and the right dosage required by patients to achieve desired results.

Bacloville is one of the main studies that have been done on the drug. The study was conducted at the Paris Descartes University and led by Philippe Jaury.  During the study, high doses of baclofen (average of 160mg per day), was administered to 320 volunteers aged 18-65 over a twelve-month period. 56.8% of the subjects on baclofen decreased their consumption to normal levels or became abstinent at the end of the period.  36.5% of subjects who were given placebos posted similar results.

The latest study at the Paul Brousse hospital, led by Michel Reynaud featured 320 subjects who were already abstinent for 20 weeks. They were given baclofen at 153mg per day. The results were less than stellar. Only 11.9% of subjects taking Baclofen remained alcohol-free while 10.5% of those on placebo did (Note from Lou: daily recommended maximum dose of Baclofen is 100mg within the UK).

While the evidence exists about the efficacy of baclofen in the treatment of alcoholism, addiction experts believe that it may not be a definitive solution for a while yet. Although clinical trials have been positive, more data is required to come to a conclusive agreement. Many, however, agree that baclofen has a higher chance of ensuring positive results in individuals that are more severely dependent on alcohol.

Side effects of baclofen

A study revealed that 88% of patients reported at least one undesirable side-effect as a result of baclofen usage. In some cases, the severity of the side-effects led to the cessation of baclofen-based treatment.

Some of the common side effects of baclofen include memory loss weight loss or gain, dysphoria, bowel disorder, sensory alterations, fatigue, sleepiness, insomnia, dizziness, nausea, paraesthesia, decrease or increase of libido, different forms of pain among other symptoms. There have been some documented cases of seizures and breathing problems as a more serious side effect.

The result of the baclofen-induced chemical alterations in the brain can equally lead to reduced efficacy of other vital medications in use by an individual.  Contraindications include psychological conditions, epilepsy, ulcers and heart-related ailments.

The dosage is decreased strategically, to combat the adverse effects of baclofen, over a two-week period with the aid of a qualified medical personal.

The effects of baclofen on alcoholism may be inconclusive, but past results make it a worthy option for alcoholics seeking remedy from their condition. However, baclofen based treatments for alcohol must only be administered by qualified professionals to avoid debilitating side effects that could prove fatal.

Personal Experience of Baclofen C Allan

I read about Baclofen and Olivier Ameison on the web-forum mywayout,org, an American based site covering most areas of alcoholism and the various methods of over coming this disease – I am not a “meeting” type of guy and indeed the thought of a meeting worried me as it would “interfere with my “drinking schedule” as every meet would be a driver away

Following a TIA in March 2015 – My Neurologist informed me that I had to make a considerable change to my personal circumstances, in particular my diet and my alcohol intake needed to improve – The results of the TIA are not noticeable externally, however there are occasions when my motor skills are confused, for instance I have to think before I can react to left and right handed commands (it is a bit like being spoken to in a foreign language and having to translate it first) and I also tend to type a lot of my words with letters the wrong way around – For instance I just wrote tpye instead of type

Having read many clinical trials papers following up on Ameison’s personal findings and the titration schedule as drawn up by French Physicians I started my initial titration on 20th December 2015 – On the 2nd January I stopped drinking, full stop, this was surprisingly easy, bearing in mind I had over the past 3+ decades consumed the equivalent to 180 units a week as I learned to pass out from the 220-250 a week unit intake I consumed at my peak – I put this solely down to Baclofen as I had tried (oh so) many times with self control – My Baclofen dosage at this time was 60mg a day. This dose was not sufficient to prevent my cravings so I continued titrating until I reached 180mg a day when my cravings ceased – As had the anxiety that I thought was a usual thing that on reflection had been the catalyst to my epic drinking history – It is moot as to whether or not Baclofen has reduced my anxiety or if the lack of alcohol has effected this – I suspect a little of both although without Baclofen, I could not have stopped drinking – Chicken and egg scenario

Anyway, I titrated up as per the French Physicians Guide (Translated by my friend David Harris), although I was not drinking against my will, I noticed a distinct lack of anxiety – I suffered this compulsively, some of the anxieties I had are on reflection, quite laughable now – At the time I did not realise that this was not normal – I thought everyone fet this way – I use an analogy to describe the feeling

It is like having a car, over the years the suspension becomes soft and saggy – You only notice how bad it has become when you replace the suspension – Because of the gradual effect of the loss of performance – My anxiety mirrored this

I was luck to make some good friends, mainly in the US, one in particular, who is IMO, a leading knowledge in Baclofen for AUD having correlated vast amounts of information and trial data over the years – He himself is an alcoholic, in remission thanks to Baclofen

I approached my GP in the early part of my titration and explained to her what my plan was – I had in the past I had heard some bad stories about GP’s reaction to non prescription medication, indeed one girl from Kent had been told to “find another GP” – My GP was terrific, she asked me to send her some information and as she could clearly see at that stage (BP and weight down) she even intimated she may even prescribe “off label” – So I took her up on her offer and sent her basically everything I could find on Baclofen 

I went back to see her four months later and she was pleased with what she saw (BP perfect and 5 stone shed) – She then prescribed me my maintenance dose of 150mg a day by prescription – It was not a financial issue, the prescription, it was the recognition by the medical profession that Baclofen has a place in alcoholism – The French, who do prescribe Baclofen for AUD are generally limited to 100mg a day with therapy – She was keen to prescribe Baclofen to her other patients – Currently I suggested this may not be a good idea for reasons I may elaborate on at another time when i have some more time

So today I am indifferent to alcohol, I can drink coffee while the others get drunk – I don’t currently need alcohol to make me someone different – 150mg a day, with a NHS prescription and the support of my GP – Cannot get much better than that.

Thank you to Mark from AddictionHelper (and Chris Allan) for this content.  I can’t advise on the use of Baclofen or the best rehabilitation for you, if that is what you need, so please do contact UK rehab who will be able to help.

 

Korsakoff’s syndrome treatment model (DDN feature)

korsakoff-syndromeToday I’m re-sharing from Alcohol Policy UK their feature post on Korsakoff syndrome (or Wernicke-Korsakoff syndrome).

This month’s Drink and Drugs News (DDN) includes a feature article exploring a new model helping Korsakoff’s syndrome sufferers back to community living. The article states:

Korsakoff’s syndrome belongs in a spectrum of disorders categorised as alcohol-related brain damage (ARBD). It is a severe memory disorder associated with excessive, long-term alcohol misuse, and results in the loss of specific brain functions due to the lack of vitamin B1 or thiamine. Post-mortem studies suggest that Korsakoff’s occurs in about 2 per cent of the population and 12.5 per cent of dependent drinkers.

However owing to limited resources and low level recognition of ARBDs, specialised service provision is particularly limited. The Arbennig Unit – part of Queen’s Court Residential Service in Conwy and run by care provider Potens – was set up in 2002 to support younger adults with alcohol-acquired brain injuries. The service aims to provide a people with Korsakoff’s opportunities for choice and independence, with the Arbennig clinical support model based on the idea that rehabilitation should aim towards a structured, alcohol-free life.

The feature says Korsakoff’s sufferers often have a chaotic lifestyle with little, if any, of the social support networks that many people take for granted. In response the Potens’ support model looks at involvement of key professionals, but does not underestimate the importance of family and friends. Korsakoff’s sufferers health has also often also been compromised by poor diet and underlying mental health issues can become more pronounced after a period of abstinence. 

However Glenn Barnett says Korsakoff patients are capable of new learning, particularly if they live in a calm and well structured environment and if new information is cued. Read the full article including case study here.

Specialised ARBD services: a rare find?

What with shrinking drug and alcohol treatment budgets, increased scope for specialist services is unlikely. Indeed a 2014 report by a collection of medical bodies called for clinical commissioning groups to support services that provide specialist care for patients with alcohol-related brain damage. It identified the scope for provision within four specialist contexts: alcohol treatment services, prisons, acute hospitals and pregnancy/fetal alcohol spectrum disorder (FASD).

In 2014 Alcohol Concern Wales also released a report warning ARBD is poorly understood by the public and many healthcare professionals, emphasising the need for early identification and treatment. Further training and clear care pathways for the diagnosis and treatment of ARBD were also recommended. However in the current context of growing populations and shrinking resources, specialist ARBD responses are likely to remain the exception rather than the rule.

I nursed many patients with this disease on the ward and even now in the community we are involved in the care of those with Korsakoff, known more colloquially as alcoholic dementia, where they sadly invariably end up on residential dementia units.

Friday Sober Jukebox – Exercise and Alcohol (Dr Feelgood)

exercise-and-alcoholThis post feels pretty autobiographical as this is exactly what I used to do.  Running on a Sunday morning with a cracking hangover was my penance for the night before excesses (and the rest of the week if I’m honest).  And now research has been done about that very thing and was covered in The Independent last month!

Regular exercise could mitigate some of the harmful effects of drinking alcohol, new research has suggested. 

However, scientists also stressed that consuming alcohol remains a potentially risky activity and suggested the study indicated the great health benefits of exercise. 

The research, for which scientists from University College London and the University of Sydney analysed the behaviour of over-forties, is described as the first of its kind. 

The habits of the subjects were compared with national health surveys from England and Scotland dating back to 1994.

Results showed those who performed regular physical activity and drank between recommended and harmful levels had a reduced risk of death from all causes associated with alcohol.

In some cases, the exercise even appeared to cancel out the risk completely. Those who only drank occasionally were also at lower risk.

With the minimum recommended amount of exercise just 150 minutes of moderate aerobic activity a week, the exercises could be activities as light as gardening, brisk walking and golf. 

However, the study did not take into account drinking habits or other dietary factors which can also influence health. 

The study said: “Our results provide an additional argument for the role of (physical activity) as a means to promote the health of the population even in the presence of other less healthy behaviours.

“The public health relevance of our results is further emphasised by the recently updated alcohol consumption guidelines review by the UK chief medical officer that found that cancer mortality risk starts from a relatively low level of alcohol consumption.”

The study, published in the British Journal of Sports Medicine, said a quarter of respondents met the higher weekly target for exercise, while just over 60 per cent did not meet the minimum recommended amount.

Just under 15 per cent did not drink at all, while 13 per cent drank more than the daily recommended maximum – when it was classified as more than 35 units per week for women and 49 units for men.

Head of health information at the World Cancer Research Fund, Sarah Toule, said: “We would not recommend that anyone sees these findings as a ‘get out of jail free card’, as alcohol does increase the risk of many different health conditions, including cancer.

“Doing more physical activity can have great health benefits and our own evidence shows that, if everyone in the UK was regularly active, about 12,000 cancer cases could be prevented every year. However, by not drinking alcohol, 24,000 cancer cases could be avoided.”

Also picked up by Reuters:

Getting regular moderate or vigorous exercise may offset some of the potentially lethal health effects of regular alcohol consumption, a new study suggests.

So exercise may help but it won’t resolve the health issues created.  However much we’d like to ‘feel good’ alcohol and post imbibing exercise isn’t the answer (and yes the link to the tune is tenuous!) 😉

PS I went to see ‘The Girl on The Train’ at the cinema last week having read the book written by Paula Hawkins when it came out last year.  OMG it was absolutely brilliant!!  Sometimes having read a book the film adaptation can be so disappointing but this one was superb (apart from the fact that the film setting was moved to the US).

Without wishing to provide any spoilers I was really heartened to see that it didn’t try to play down or minimise how important Rachel’s alcoholism and black outs were to the story.    As The Guardian review says: “Most importantly, in the shape of the mercurial Emily Blunt, The Girl on the Train has a believably derailed heroine whose hollow eyes, crusty lips and stumbling gait convey Leaving Las Vegas levels of addiction while still retaining an air of mystery and intrigue.”  and as one of the comments on the review said: Her drunken lurching in and out of reality as she desperately tried to work out what she had/hadn’t seen or done were heart breakingly realistic. As someone who has an alcoholic in the family it really hit home.

Here’s the trailer 🙂

Even moderate drinkers are at greater risk of cancer – New Zealand study

breast cancer riskThis was featured in the Daily Mail in July looking at a 2012 cancer study from New Zealand where the findings showed that even moderate drinkers alcohol consumption affected risk rate.

It is known that drinking excess alcohol can increase a person’s risk of various cancers.

But now, a new study has revealed even moderate drinkers should be concerned.

Indulging in less than two alcoholic beverages a day, puts drinkers at heightened risk of breast and bowel cancer – two of the most deadly forms of the disease.

Furthermore, experts at the University of Otago, said alcohol is also linked to cancer of the mouth, pharynx, oesophagus, larynx and liver.

Researchers found alcohol was responsible for 236 cancer deaths in people aged younger than 80 in New Zealand in 2012.

Lead author, professor Jennie Connor at Otago Medical School, said the findings relating to breast cancer were particularly sobering.

‘About 60 per cent of all alcohol-attributable cancer deaths in New Zealand women are from breast cancer,’ she said.

‘We estimated 71 breast cancer deaths in 2007 and 65 in 2012 were due to drinking, and about a third of these were associated with drinking less than two drinks a day on average.

‘Although risk of cancer is much higher in heavy drinkers there are fewer of them, and many alcohol-related breast cancers occur in women who are drinking at levels that are currently considered acceptable.’ 

The study, a collaboration with the Global Burden of Disease Alcohol Group, and published in the journal Drug and Alcohol Review, builds on previous research that identified 30 per cent of all alcohol-attributable deaths in New Zealand to be be linked to cancer, more than all other chronic diseases combined.

It uses evidence that alcohol causes some types of cancer after combining dozens of large studies conducted internationally over several decades.

The cancers that are known to be causally related to alcohol include two of the most common causes of cancer death in New Zealand, breast and bowel cancer, but also cancer of the mouth, pharynx, oesophagus, larynx and liver. 

This New Zealand study estimated mortality for 2007 and 2012. 

Professor Connor added: ‘There was little difference between men and women in the number of cancer deaths due to alcohol, even though men drink much more heavily than women, because breast cancer deaths balanced higher numbers of deaths in men from other cancer types.

‘These premature deaths from cancer resulted in an average 10.4 years of life lost per person affected, with more loss of life among Māori than non-Māori, and for breast cancer compared with other cancers.’

Professor Connor said while these alcohol-attributable cancer deaths only account for 4.2 per cent of all cancer deaths in people under the age of 80, what makes them ‘so significant is that we know how to avoid them’.  

‘Individual decisions to reduce alcohol consumption will reduce risk in those people,’ she said. 

‘But reduction in alcohol consumption across the population will bring down the incidence of these cancers much more substantially, and provide many other health benefits as well.

‘Our findings strongly support the use of population-level strategies to reduce consumption because, apart from the heaviest drinkers, people likely to develop cancer from their exposure to alcohol cannot be identified, and there is no level of drinking under which an increased risk of cancer can be avoided.

‘We hope that better understanding of the relationship of alcohol with cancer will help drinkers accept that the current unrestrained patterns of drinking need to change.’

Further coverage:

Alcohol is a direct cause of seven forms of cancer, finds study
Alcohol ‘a direct cause of seven types of cancer’

“Even one glass of wine a day raises the risk of cancer: Alarming study reveals booze is linked to at least seven forms of the disease,” reports the Mail Online. The news comes from a review that aimed to summarise data from a range of previous studies to evaluate the strength of evidence that alcohol causes cance. The study was published in the peer-reviewed scientific journal Addiction. It is available on an open-access basis and is free to read online | NHS Choices: Behind the Headlines, UK

Not new research but it re-enforces for me the value of the new UK drinking recommendations and the message that there is no safe level of alcohol consumption where our health is concerned.

What alcohol REALLY does to your body – and how quickly you can repair the damage

12 weeksThis was in the Daily Mail in June and looked at what alcohol does to the body and the time frame needed to begin to repair the damage.

From the pounding headache to the feeling of regret, we all know that alcohol isn’t good for our bodies.

When nursing a hangover it’s not unusual to vow to never allow alcohol to pass your lips again. Yet weeks – perhaps even days – later, social drinkers find themselves in the same situation. 

But a new guide revealing what really happens to your body when you stop drinking may well discourage you from reaching for that chilled glass of white again.

From flawless skin to new levels of energy, Dr Niall Campbell, an alcohol addiction expert at the Priory hospital in south-west London, reveals the timeline – and benefits – of ditching the booze.

WITHIN 24 HOURS 

The most immediate effect of excess alcohol is a hangover. You might suffer sweats or tremors, and in severe cases, a seizure. If you are giving up moderate drinking, your body will begin to clear the alcohol from your system and you can start to ‘detox’, your blood sugar will normalise and you can look forward to the multiple advantages that not drinking will bring you. 

You will feel much more clear-headed, less depressed and you will have more money in your wallet. If you spend, say, around £20 a week on 2 bottles of wine, you will save £1,040 by the year’s end.

WITHIN A WEEK 

Alcohol is very bad for sleep, leading to a fitful night. You may think it gets you off to sleep but you are likely to wake up and want to go to the bathroom. 

Alcohol is a diuretic, which means it encourages the body to lose extra fluid though sweat, making you dehydrated which means you will wake up wanting water. The good news is that if you give up alcohol, your sleep patterns are likely to improve within a week.

WITHIN A FORTNIGHT 

Alcohol is an irritant to the stomach lining and causes symptoms like reflux (where stomach acid burns your throat). Give up alcohol and this feeling will be a thing of the past.

You will also start to notice weight loss within a fortnight. The ‘hidden’ calories in alcohol are significant. Drinking a large glass of wine (250ml) with 13 per cent ABV can add 228 calories to your dinner. So two large glasses will add roughly the equivalent of an extra ham and cheese sandwich with mayonnaise a day. And we are talking empty calories, which means they contain no nutrition. 

If you stop drinking, and start eating healthily and exercising, you will lose weight.

WITHIN 3-4 WEEKS 

If you drink too much alcohol, this raises your blood pressure over time. The calories in alcohol also make you gain weight, which also increases your blood pressure. By quitting alcohol, your blood pressure will reduce.

WITHIN A MONTH 

You will look visibly better. Alcohol is toxic to your largest organ – your skin. The toxins make your skin less elastic and it is very ageing. Ageing through alcohol is something your best friend won’t tell you about. If you stop drinking, you prevent premature ageing of your skin.

WITHIN 4-8 WEEKS 

Your liver will improve. It can handle small quantities, but excessive drinking causes it to get inflamed – which is what we call ‘alcoholic hepatitis’, a silent disease. In the early stages, you can’t feel that, but it can lead to cirrhosis, which is permanent. 

Drinking a couple of 175ml glasses of wine a day if you’re a woman, for two or three weeks, and you’re likely to develop ‘fatty liver’, when the liver turns glucose into fat. Alcohol affects the way the liver handles fat, so your liver cells just get full of it. 

The good news is your liver will start shedding the excess fat if you stop drinking. If your liver function has not been too badly affected by alcohol, it can recover in 4-8 weeks.

WITHIN 12 WEEKS 

Heavy drinking causes blood cells to become larger and that makes you more tired because they are unable to transport oxygen efficiently around the body. 

After giving up drinking, your blood cells will start to renew within three months and you will feel much more energetic and healthier all round.

And that’s after only 12 weeks!  Imagine what you’ll feel like after 6 months or a year or in my case almost 3 years 😉