Category Archives: Physical

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 😉

25% of males age 15-39 die due to alcohol

fatal alcohol poisoningThis was in the Irish press in June looking at the number who die due to alcohol in young males and it is shocking.

One in four deaths of young men aged from 15 to 39 in Ireland is due to alcohol and drink is a factor in half of all suicides, according to the Health Research Board.

Alcohol is also involved in more than one third of cases of deliberate self-harm, peaking around weekends and public holidays.

Those grim statistics are among the challenges for the medical professional nationwide and yesterday the first regional Alcohol Strategy to tackle the damage caused by alcohol in counties Cork and Kerry was launched at Cork County Hall.

“Our overarching principle in terms of strategy is to reduce the harm caused by alcohol in Cork and Kerry,” said David Lane, co-ordinator of Drug & Alcohol Services at HSE South.

While welcoming the new Public Health (Alcohol) Bill, Mr Lane said its slow progress through the legislature was frustrating.

“We need this new legislation as a matter of urgency,” he said.

“In fact, the minimum unit pricing which is a central plank of the Bill should have been put in place years ago. In the meantime, more than one person every week in this country dies of alcohol poisoning. They just consume alcohol and no other drug and die from it. That is quite shocking.”

Among the HRB findings: n Alcohol consumption in Ireland almost trebled between 1960 (4.9 litres) and 2001 (14.3 litres); n Almost two thirds (63.9%) of males started drinking alcohol before the age of 18; n Four in five (80.3%) male drinkers consumed six or more standard drinks on occasion.

Those attending the launch of the strategy heard that liver disease rates are increasing rapidly in Ireland and the greatest level of increase is among 15- to 34-year-olds, who historically had the lowest rates of liver disease.

As well as that, 900 people are diagnosed with alcohol-related cancers with around 500 people dying from these diseases every year. Drink driving is also factor in one third of all deaths on Irish roads.

The bill aims to reduce alcohol consumption in Ireland to 9.1 litres per person per annum by 2020 and to reduce the harms associated with alcohol. It consists of 29 sections and includes five main provisions.

These are: Minimum unit pricing; health labelling of alcohol products; the regulation of advertising and sponsorship of alcohol products; structural separation of alcohol products in mixed trading outlets; and the regulation of the sale and supply of alcohol in certain circumstances.

However, Mr Lane lamented the absence in the proposed legislation of any attempt to tackle seriously the marketing of alcohol, particularly in its association with sporting events.

“We might be turning a corner,” said Mr Lane.

“The Public Health (Alcohol) Bill outlines some positive steps to tackle the issue for the first time in a meaningful way.

“It might be the first step in introducing minimum unit pricing which we, as an Alcohol Strategy Group for Cork and Kerry, will fully support. But Ireland needs to strengthen its resolve to tackle the availability and marketing of alcohol in a meaningful way too.

“Finally, we must include alcohol as part of our response to substance misuse and when our National Drugs Strategy runs out at the end of 2016 we must include alcohol in a new National Substance Misuse Strategy from the start of 2017.”

And the same day this study abstract was published too:

Alcohol dependent individuals show greater risk of suicide in evening hours

A new study found that there is a circadian pattern of peak and nadir in the incidence of suicides committed in alcohol dependent individuals.

Subjects who consumed heavy amounts of alcohol had a peak incidence of suicide at 9PM, and a low around 5PM. In contrast, the peak incidence was around 12 PM for those individuals who did not drink or drank moderately and a low at 4 AM.

What struck me about the Irish news story was how even though they the Public Health (Alcohol) Bill has been passed it’s implementation is being slowed.  Why is that and by whom?

To which there was no answer but an impassioned plea:

Royal College of Physicians of Ireland calls for the urgent enactment of the Public Health Alcohol Bill

Access to alcohol and heart disease among patients in hospital

alcoholic cardiomyopathyThis was some research published in the BMJ in June looking at ‘access to alcohol and heart disease among patients in hospital: observational cohort study using differences in alcohol sales laws’.

I’ll detail the abstract and then the relevant bits of the discussion which caught my eye:

Abstract

Objective To investigate the relation between alcohol consumption and heart disease by using differences in county level alcohol sales laws as a natural experiment.

Design Observational cohort study using differences in alcohol sales laws.

Setting Hospital based healthcare encounters in Texas, USA.

Population 1  106 968 patients aged 21 or older who were residents of “wet” (no alcohol restrictions) and “dry” (complete prohibition of alcohol sales) counties and admitted to hospital between 2005 and 2010, identified using the Texas Inpatient Research Data File.

Outcome measures Prevalent and incident alcohol misuse and alcoholic liver disease were used for validation analyses. The main cardiovascular outcomes were atrial fibrillation, acute myocardial infarction, and congestive heart failure.

Results Residents of wet counties had a greater prevalence and incidence of alcohol misuse and alcoholic liver disease. After multivariable adjustment, wet county residents had a greater prevalence (odds ratio 1.05, 95% confidence interval 1.01 to 1.09; P=0.007) and incidence (hazard ratio 1.07, 1.01 to 1.13; P=0.014) of atrial fibrillation, a lower prevalence (odds ratio 0.83, 0.79 to 0.87; P<0.001) and incidence (hazard ratio 0.91, 0.87 to 0.99; P=0.019) of myocardial infarction, and a lower prevalence (odds ratio 0.87, 0.84 to 0.90; P<0.001) of congestive heart failure. Conversion of counties from dry to wet resulted in statistically significantly higher rates of alcohol misuse, alcoholic liver disease, atrial fibrillation, and congestive heart failure, with no detectable difference in myocardial infarction.

Discussions The relation between heart failure and alcohol use has been one of the more complex associations to elucidate. On the one hand, alcohol is known to cause cardiomyopathy.29 30 On the other hand, some studies have suggested that alcohol may have a protective effect when consumed in moderation.14 15 Both atrial fibrillation and myocardial infarction can lead to heart failure,31 32 with myocardial infarction likely being much the more important of the two.

The discordant results, showing more atrial fibrillation but less myocardial infarction and congestive heart failure in wet compared with dry counties, are particularly remarkable given that these outcomes generally share all of the same risk factors and that each can lead to the other. Specifically, atrial fibrillation predicts myocardial infarction and congestive heart failure,31 35 36 37 just as myocardial infarction predicts atrial fibrillation7 38 39 and congestive heart failure predicts atrial fibrillation.7 31 Therefore, given these potential “downstream” influences, these discordant results may suggest that the direct effects of alcohol are more potent than the point estimates reported.

Conclusions Greater access to alcohol was associated with more atrial fibrillation and less myocardial infarction and congestive heart failure, although an increased risk of congestive heart failure was seen shortly after alcohol sales were liberalized.

I’ve often wondered about alcohol and the heart and wanted to see some research to validate my experience.  The youngest patient I ever nursed whose death was alcohol-caused was a 36 year old female who died of alcohol induced cardiac failure.  Plus in the TV twin study  a cardiologist used ultrasound to observe their heart during drinking and noticed cardiac dilation.

There was an editorial in the BMJ the same day titled Pinpointing the health effects of alcohol that critiqued this study that concluded with:

Both proponents and skeptics of the hypothesis that alcohol consumption reduces cardiovascular risk should recognize that nothing short of a randomized trial of alcohol consumption will provide the quality of data necessary to answer this question with confidence, because any observational design will be subject to serious limitations. All interested parties should press for such a trial quickly and wholeheartedly. It is time to move forward.

I look forward to reading the results of this RCT and also the detailed limitations and confounding variables!!

Edited to add:

The MailOnline reported research about atrial fibrillation in its article ‘Why drinking just ONE glass of wine a day could now be bad for you.’ | Alcohol Policy UK

Edited to add: 6th Feb 2017

The Express reported on research that found alcohol abuse was associated with a doubled risk of irregular heartbeat, a 1.4-fold increased risk of heart attack and a 2.3-fold increased risk of heart failure.

 

 

Is addiction really a disease?

is addiction really a diseaseA perennial recurring discussion (in my head anyway!) …..  From this week-end’s Observer Marc Lewis  author of The Biology of Desire: Why Addiction Is Not A Disease.

What is addiction? For the majority who have strong opinions on the matter, addiction is a disease. In fact it’s “a chronic relapsing brain disease” according to the American National Institute on Drug Abuse. This definition, born of the marriage between medicine and neuroscience, is based on the finding that the brain changes with addiction. It’s a definition that’s been absorbed and disseminated by rehab facilities, 12-step programmes, policy makers and politicians. It’s the defining credo of the addiction-treatment industry. But is it correct?

A counter argument is gathering momentum. Many are coming to see addiction as a learned pattern of thinking and acting – a pattern that can be unlearned. As a neuroscientist, I recognise that the brain changes with addiction, but I see those changes as an expression of ongoing plasticity in an organ designed to change with strong emotions and repeated experiences. Similar changes have been recorded when people fall in love, become obese, gamble compulsively, or overindulge on the internet. And as a developmental psychologist (my other hat), I see addiction as an attitude or self-concept that grows and crystallises with experience, often initiated by difficulties in childhood or adolescence. Indeed, addiction is in some ways like a disease, but that’s only half the story.

The debate rages on, and it has propagated a good deal of antipathy among addiction experts and the populations they serve. I had a taste of that conflict just last month. I was invited to join a radio discussion that turned ugly when a scientist and proponent of the disease model claimed that anyone who didn’t recognise addiction as a disease was trivialising it. To back this up, he spoke of several of his close friends who had died because they could not stop drinking. While cases like these are heartbreaking, I am compelled to ask: how can we say addicts can’t stop when so many of them eventually do?

It’s an argument that seems endless. But if there’s no right answer, the best answer might be the one that generates the greatest benefits and causes the least harm. For me, that scorecard is filled in by addicts themselves. Many take comfort in the disease label, because it helps them make sense of how difficult it is to quit. But for others, the disease label isn’t just wrong, it’s repugnant – it’s a rationale for helplessness and an obstacle to healing.

“I hated being told I had a disease,” wrote a recent commenter on my blog. “I am not diseased… I don’t have a disease. I had past traumas, environmental factors and learned behaviours… I feel I have learned new things… new skills opened up… new pathways that were underdeveloped.” That’s the crux of the matter for addicts who reject the yoke of fatalism implicit in the disease definition. The first of the 12 steps, admitting that one is powerless, is their point of departure. That’s when they leave their first meeting. And they don’t come back.

Research suggests their intuitions are correct. Several studies have shown that a belief in the disease concept of addiction increases the probability of relapse. And that shouldn’t be surprising. If you think you have a chronic disease, how hard are you going to work to get better?

If we can acknowledge that addiction is like a disease in some ways and very much unlike a disease in other ways, maybe we can stop trying to label it and pay more attention to the best means for overcoming it.

Have to say I agree with him – what do you think?

Edited to add 4.15pm: As a nod to the image of Ewan McGregor as Renton in Trainspotting at the start of this blog and serendipitously launched today 😉

Teaser trailer for Danny Boyle’s Trainspotting sequel – video

Researchers find brain circuit that controls binge drinking

addiction-circuitry-in-human-brain-23-638This research was published in April and picked up by Science Daily looking at addiction and the human brain and particularly the brain circuit that controls binge drinking.

Researchers at the University of North Carolina at Chapel Hill have identified a circuit between two brain regions that controls alcohol binge drinking, offering a more complete picture on what drives a behavior that costs the United States more than $170 billion annually and how it can be treated.

The two brain areas — the extended amygdala and the ventral tegmental area — have been implicated in alcohol binge drinking in the past. However, this is the first time that the two areas have been identified as a functional circuit, connected by long projection neurons that produce a substance called corticotropin releasing factor, or CRF for short. The results provide the first direct evidence in mice that inhibiting a circuit between two brain regions protects against binge alcohol drinking.

“The puzzle is starting to come together, and is telling us more than we ever knew about before,” said Todd Thiele of UNC-Chapel Hill’s College of Arts and Sciences, whose work appears in the journal Biological Psychiatry. “We now know that two brain regions that modulate stress and reward are part of a functional circuit that controls binge drinking and adds to the idea that manipulating the CRF system is an avenue for treating it.”

The extended amygdala has long been known to respond to psychological stress and anxiety, such as when someone loses a job or a loved one; and the ventral tegmental area to the rewarding properties of natural reinforcers, such as food, but also to the reinforcing properties of drugs of abuse, including alcohol.

In their work, Thiele and colleagues show that alcohol, a physiological stressor, activates the CRF neurons in the extended amygdala, which directly act on the ventral tegmental area. These observations in mice suggest that when someone drinks alcohol, CRF neurons become active in the extended amygdala and act on the ventral tegmental area to promote continued and excessive drinking, culminating in a binge.

Thiele said these findings may shed light on future pharmacological treatments that may help individuals curb binge drinking and may also help prevent individuals from transitioning to alcohol dependence.

“It’s very important that we continue to try to identify alternative targets for treating alcohol use disorders,” Thiele said. “If you can stop somebody from binge drinking, you might prevent them from ultimately becoming alcoholics. We know that people who binge drink, especially in their teenage years, are much more likely to become alcoholic-dependent later in life.”

It will be interesting to see how they use this research knowledge to help prevent individuals transitioning to alcohol dependence.

 

Bacon and alcohol increase stomach cancer risk, report finds

bacon-sandwich-stock-image-sarnie-butty-This was in The Independent in April and looking at new research that links alcohol (and processed meats) to increased stomach cancer risk.

Eating processed meat such as bacon and drinking alcohol has been “strongly” linked to stomach cancer for the first time.

People eating 50g of processed meat a day, equivalent to two rashers of bacon, was found to have an increased risk of stomach cancer, according to a new study from the World Cancer Research Fund (WCRF).

The study stated those who drink three or more alcoholic drinks a day are also at increased risk.

However, there is evidence eating citrus fruits may reduce risk, experts say.

The report defines processed meat as “meat that has been preserved by smoking, curing or salting, or by the addition of preservatives.

“Examples include ham, bacon, pastrami and salami, as well as hot dogs and some sausages.”

Experts also pointed to “strong evidence” that consuming foods preserved by salting increased the risk, such as pickled vegetables and salted or dried fish.

Over 7,000 people are diagnosed with stomach cancer each year in the UK, leading to around 5,000 deaths.

Eighty per cent of people are diagnosed once the cancer has started spreading around their body.

According to Cancer Research UK, doctors believe a patient is doing well if they are still alive two years after being diagnosed with advanced stomach cancer.

Men are twice as likely to contract stomach cancer than women with the cancer more likely to occur in adults.

Processed meat was already linked to bowel cancer, while being overweight or obese is linked to 10 different cancers.

The scientists also reported there was “some evidence that suggests consuming grilled or barbecued meat and fish increases the risk of stomach cancer”.

Dr Rachel Thompson, head of research interpretation at the WCRF, said: “This new evidence gives us a clearer picture.

“We can now say, for the first time, that drinking alcohol, eating processed meat and being overweight or obese can all increase the risk of developing stomach cancers.

“These findings will hopefully help people better understand what increases their risk of cancer so that they can make informed decisions about their lifestyles choices.”

In the UK, the lifetime risk of stomach cancer stands at one in 67 for men and one in 135 for women.

And how often did I use a bacon sarnie to sop up a hangover the morning after the night before??

The rise of the young female drinkers who open a bottle at wine o’clock each night

drinking to oblivionSo this was in the Evening Standard in April prior to the airing of the Louis Theroux documentary ‘Drinking to Oblivion’ which I feature here.   The article focused particularly on young women and wine o’clock – my demographic!

A growing number of young professional women are putting their health at risk by drinking excessively at home, a top doctor warned today.

Professor John O’Grady, consultant hepatologist at King’s College Hospital, said women in their twenties and thirties were being diagnosed with liver cirrhosis — a condition more typically found in men a decade older.

He spoke out ahead of a BBC2 documentary by Louis Theroux, Drinking To Oblivion, which shows the battle at the hospital, in Denmark Hill, to help some of the capital’s most “chaotic” drinkers.

Mr O’Grady said the women had typically drunk about 50 units of alcohol a week — equivalent to around five bottles of wine. The recommended maximum is 14 units.

He said: “The kind of story you get is, ‘I get home from work and share a bottle of wine with my partner. I do that every single day. Then at the weekends I party and drink a bit more.’

“That is a commonly recurring story from young women who didn’t expect to be at risk of liver disease. It becomes part of the routine. Twenty or 30 years ago, if you were going to drink you’d probably make a decision to go to the pub.”

Better screening and check-ups for medical insurance had led to more people being diagnosed with the illness, he added: “I am seeing more and more young women, and by young I mean under the age of 40. Women in their twenties and thirties present with liver disease that is more typically related to men about 10 years older.”

He warned that there was no strict correlation between the amount a person drinks and the risk of cirrhosis: “For every person who gets cirrhosis, there will be about five who have drunk the same amount who get no liver disease.

“People think because they’re not drinking any more or less than their friends or peers they don’t have a problem.” About one in three Britons drinks excessively. Professor O’Grady called for people to pro-actively undergo blood tests every couple of years to check on the health of their liver.

Andrew Langford, chief executive of the British Liver Trust, said: “Both young and middle-aged women are the big growth area in terms of alcohol-related liver disease.

“It’s bad enough when a young woman is at home sharing a bottle of wine with her partner. But there are an awful lot of women who don’t have a partner, so they drink the bottle of wine themselves.

“The other group is mums who get into the habit of getting the kids to bed and opening a bottle of wine. It’s become a social norm and a joke: that it’s ‘wine o’clock’.

“It’s that shift where alcohol is very much a commodity for a lot of us. Within a couple of generations we have allowed alcohol to become something we buy alongside our eggs, milk and bread.”

This was me – from with partner, to when single, to being a mother.  Tick, tick, tick ……

Is Alcohol Now the Scourge of Older People and Younger Women?

On 5 May 2016, Public Health England publishes its annual statistics for alcohol related hospital admissions for England. Traditionally the scourge of younger and middle-aged men, we have seen a very different picture from alcohol related deaths, the data for which was published earlier this year | Huffington Post Blog, UK

This is the data that Dr Rao talks about in the Huff Post Blog:

Local Alcohol Profiles for England: hospital admissions indicators, 2016 annual data update

The Local Alcohol Profiles for England (LAPE) data update for May 2016 | PHE, UK

All posts on older drinkers are here.

Edited to add: 8th October 2016

The MailOnline looked at women’s drinking in: ‘Why do so many intelligent young women drink to oblivion? Three self-confessed binge drinkers reveal what drives them to booze’ | Alcohol Policy UK

‘Ladies who lunch’ get medical implants to beat cravings for wine

naltrexone implantThis was in the Irish press in April looking at the use of naltrexone implants being used to manage alcohol dependency.

Middle- aged Irish women, enslaved to nightly bottles of wine, are being treated for alcoholism with surgical implants that have traditionally been administered to heroin users, according to one of Ireland’s leading experts on alcohol and drug addiction.

The implant, containing a drug called Naltrexone, lasts for three months and is administered during a 15-minute procedure under a local anaesthetic at a cost of €1,150.

Dr Hugh Gallagher, a HSE GP co-ordinator in addiction service and head of the One Step Clinic, has said that the implants are being used by women in their 30s, 40s and 50s, who are the new major drug-dependency problem in Ireland.

This group of women is bucking the national trend, under which alcohol consumption has fallen by 25pc from its peak Celtic Tiger levels.

According to Dr Gallagher, the new cohort of overworked, tired and unhappy Irish women are increasingly turning to alcohol for consolation.

Speaking to the Sunday Independent this weekend, Dr Gallagher said: “Traditionally, we were dealing with males in their 50s or 60s. It has now changed to a problem which is crossing society and genders. Middle- and upper-class women are presenting too; it’s very much across the board.”

Dr Gallagher said women were “ambivalent” towards their wine consumption and alcohol-fuelled lunches.

“A treat becomes an entitlement. They feel they deserve this every other day, or at the end of each day and it can become quite troublesome.”

The addiction expert describes the culture shift with women and drinking that has emerged since the Nineties.

“The trend started out with Babycham marketed for women as a nice, feminine, sparkling drink. Then we headed from there to the ‘Ladette’ culture of the Nineties and female celebrities being photographed leaving clubs and pubs during nights out. From there we had the Sex and the City culture and Bridget Jones era and it has been a progression during that time, which has continued.”

He also said the feminist revolution had put increasing workloads and expectations on women.

“Women now have to perform in the boardroom, the kitchen and the bedroom. There is more pressure, more stress, they are going out to work but they are also keeping the family going and in charge of most of the household and they are starting to have a wee drink on a Friday evening, because they feel they deserve it, and then opening a bottle of wine on a week day night.

“That can progress to every night during the week at dinner to maybe throwing down the keys as soon as they come in the door and opening a bottle of wine straight away. That is the pattern we are seeing.”

The addiction specialist also said a ‘ladies who lunch’ culture, which has emerged in middle- and upper-class Ireland, was adding to the worrying trend.

Commenting on the new social fixture, he said: “In our mothers’ time, meeting a group of friends to chat and catch up was traditionally done over a cup of tea but that has now dramatically changed to centre around wine.

“Women meeting up once or twice a week for lunches, where they don’t notice their glass being constantly refilled, their husbands are at work, the kids are at college or at school and they’re feeling bored or neglected or whatever the case may be.

“I find it baffling and extremely worrying. That is not innocent behaviour. It simply isn’t. Someone who is doing that on a regular basis is putting themselves at a very significant risk of developing problems.

“And the problems, the reasons behind the drinking, are perpetuated by alcohol and it then becomes a vicious cycle.

“We heard in America about the Upper East Side Manhattan hedge fund wives (HFW) and we have the same problem in Ireland. This type of group drinking, it’s not dissimilar to what happens to guys in parks and fields. It is just a different presentation.”

Since opening the One Step programme 18 months ago, Dr Gallagher is seeing hundreds of patients from all over the country. The part-time rehab programme allows patients to overcome their problems while still attending work each day.

Many are using the Naltrexone in conjunction with counselling sessions.

Naltrexone is a drug that blocks the effects of heroin and reduces the ‘pleasure’ or ‘highs’ associated with alcohol consumption.

Part of the pleasurable effect from alcohol happens through opiate receptors. When these receptors are blocked, people get fewer cravings for alcohol and less pleasure if they do drink.

It becomes much easier for them to stay abstinent and continue with their recovery.

These are being prescribed and inserted in Southern Ireland so I’m unsure if these are available in the UK.  Further research also released the same day:

Critical Measures: Next Steps in Alcohol Research and Policy – presentations

This conference presented new evidence on patterns of alcohol use across the UK, alcohol risks and harm, developing interventions, and reflections on the relationship between alcohol research and evidence-informed policy | Alcohol Research UK, UK

Are 3 questions enough to detect unhealthy alcohol use?

CAGE questionsThis was a meta-analysis featured on Drugs and Alcohol Findings in April and looking at the questions used to assess and detect unhealthy alcohol use.

Both AUDIT and AUDIT-C are known to accurately detect unhealthy drinking, but is one more accurate than the other? This paper looks for answers in 14 studies from across Europe and in the United States.

Summary The Alcohol Use Disorders Identification Test (AUDIT) was developed in 1993 by the World Health Organization, and is one of the most frequently recommended and researched diagnostic tests for detecting unhealthy drinking, alongside the Cut-Down, Annoyed, Guilty, and Eye-opener (CAGE) questionnaire and the Michigan Alcoholism Screening Test (MAST).

An abbreviated version of AUDIT, the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), was introduced a few years later. AUDIT-C is made up of three questions about alcohol intake from the full AUDIT, which also asks another seven questions about alcohol-related problems and symptoms indicative of dependence.

Evidence shows that AUDIT-C can be a useful and valid screening test for unhealthy drinking, as demonstrated in this study with patients in a Brazilian emergency department, and this study in three Veterans Affairs general medical clinics in the United States. Some differences have been found in the performance of AUDIT compared with AUDIT-C, but the authors of the present paper argue that the accuracy of one versus the other has not (until this study) “undergone systematic examination”.

This paper is based on a meta-analysis, amalgamating results from 14 studies which directly compared the accuracy of AUDIT-C with AUDIT for the detection of unhealthy drinking. The authors selected these studies as directly relevant and meeting pre-defined inclusion and quality criteria from a systematic search of six online databases, within a date range of 1998 and 2008.

Main findings

The reported findings focus on primary care, as this was the most intensively researched setting. Eight of 14 studies were based in primary care, compared with four in general population samples, two in inpatient samples, and zero studies in an emergency department. The ‘target conditions’ of the 14 studies varied, but included risky drinking, harmful drinking, alcohol abuse, alcohol dependence, alcohol use disorder and unhealthy drinking (the latter covering the full spectrum from risky drinking to any alcohol use disorder).

Accuracy of the two tests was measured in a range of ways. For the purposes of this account, those easiest to interpret and most meaningful were “sensitivity” and “specificity”. In the current context, sensitivity can be understood as the proportion of respondents identified as risky drinkers by AUDIT or AUDIT-C who really are (normally as judged by a more comprehensive assessment) risky drinkers, while specificity is the proportion found not to be risky drinkers by these questionnaires who really are abstinent or drinking in a non-risky manner. Together these measures tell us how well the questionnaires pick up on risky drinking without also drawing into the net large numbers of non-risky drinkers.

The authors found considerable variation in the results of the tests, and variation in the way the tests were implemented. For example, the proportions of primary care patients identified as risky drinkers ranged from 11% to 35%, and the choice of threshold scores for risky drinking in primary care settings varied between 4 and 8 for the AUDIT test, and between 3 and 5 for AUDIT-C.

Overall, the accuracy of AUDIT and the AUDIT-C did not differ to a significant degree for screening for risky drinking, alcohol use disorders, or unhealthy drinking in primary care settings. However, one of the ways of comparing the tests did indicate a significant if small advantage for AUDIT over AUDIT-C in the identification of risky drinking (ie, above recommended maximums) in primary care settings. This measure was the ratio between the proportion of patients correctly identified as risky drinkers versus those incorrectly identified – the so-called ‘positive likelihood ratio’. The higher this ratio, the better the test is at correctly distinguishing who really is a risky drinker. For AUDIT the ratio was over twice as high (6.6 versus 3.0), a statistically significant difference.

With any such test there is trade-off between setting the threshold high so that nearly all those identified as risky drinkers really are, versus the increased chance that many risky drinkers will score below this threshold and fail to be spotted. This trade-off worked differently for the two tests. AUDIT-C’s ability to spot risky drinkers suffered less when such a high threshold was set that at least 85% of those who scored as risky drinkers really were. An alternative strategy is to set a low threshold, effectively casting a wide net so that nearly all drinkers in need of intervention are identified, while accepting that at the same time more people will be falsely identified as risky drinkers. In this scenario AUDIT was the more robust test, its ability to correctly exclude non-risky drinkers suffering less.

The authors’ conclusions

Although this study found no significant difference between the accuracy of AUDIT and AUDIT-C in primary care settings, this does not mean that it provides evidence of equivalent levels of accuracy of the two tests. It could be the case that with so few studies and with so many variations between the studies, the tests really do differ in accuracy, but research has yet to establish this. Indeed, some results (such as the difference between positive likelihood ratios when screening for risky drinking in primary care) indicated that AUDIT may be superior to AUDIT-C.

There are also some features beyond the degree of accuracy that may influence a practitioner’s choice of a diagnostic test. For example, the authors argue that the full AUDIT may “serve as a starting point for the exploration of the alcohol problem in a general practice situation because of its questions about the consequences of alcohol use. The MAST can provide a detailed description of a potential alcohol problem in settings where time constraints are not crucial. Finally, the CAGE test, with its 4 easily memorisable yes-or-no questions, may be preferable to both the AUDIT and the AUDIT-C, which have several response categories”.

Kriston L., Hölzel L., Weiser A.K., et al.  Annals of Internal Medicine: 2008, 149(12), p. 879–888.

So the study is 8 years old but is a meta-analysis which makes it robust.

I would add that I always used to read the CAGE questions and justify that I didn’t meet the criteria because no one had criticised my drinking and I didn’t meet the eye-opener one because I didn’t drink in the morning.  That said there had been occasions when I’d been up until the small hours drinking (4-5am) and we’d gone to the pub for lunch the next day where a bloody mary had been used to manage a hangover – you know hair of the dog and all that.  I would argue that the time between stopping drinking the night before and a lunch time livener would have met that definition after all ………

Alcohol and Diabetes

alcohol and diabetesAlcohol Concern have done it again!  Producing an excellent information sheet on alcohol and diabetes a chronic life-limiting illness where rates of diagnosis are climbing exponentially in this country partly because of the increasing rates of obesity.
In 2010 as many as three million people were estimated to have diabetes in England.  The condition can lead to a number of serious health conditions. It has been estimated that Type 2 diabetes, the most common form of the condition, costs the UK economy nearly £9 billion every year – a figure which is set to sharply increase in the future.
Here it is:
And the take-away?
Consuming large amounts of alcohol – particularly through binge drinking – may increase the risk of developing Type 2 diabetes. While people who have developed diabetes do
not necessarily need to give up alcohol, those treating it with tablets or insulin should monitor their blood glucose levels whenever they are consuming alcohol.