Drink, Politics and stuff

My wife wrote this for her Med degree – she has to write at least one of these a week at the moment, plus study.  She’s having it hard at the moment.  Anyway, thought some who read this might find it of interest.  Be honest with your self – are there three you recognise (read on to see what I mean)…

REFLECTIVE COMMENTARY
Alcohol Dependence Syndrome

 The relationship between levels of alcohol and harm is not straightforward as alcohol in any amount is a hepatotoxin.  However it is generally agreed that below a certain level the risk of serious damage is sufficiently low to be termed safe.  Alcohol consumption is graded in units with 1 unit being equal to 8g of ethanol, the equivalent of 1 small glass of wine, a ½ pint of beer or a standard measure of spirits.  ‘Safe’ Limits are accepted as,

• 21 units per week for men
  
• 14 units per week for women,
  

provided there is not more than 6 units in one day and there are occasionally drink free days.
 Types of Alcohol Misuse:
Dangerous Use of Alcohol
A level of alcohol consumption that significantly increases the risk of harm.  Dangerous levels are:

• >50 units a week for men
  
• >35 units for women.
  

 Levels between safe and dangerous are referred to as hazardous.
 Harmful Use of Alcohol
A level of alcohol consumption that has caused actual mental or physical harm.
 Problem drinking
Drinking that has caused mental, physical or social harm.
   Risk factors for high levels of alcohol consumption

• Genetic factors
  
• • Harmful drinking runs in families, although how  much of this is due to genetics and how much to the environment is unclear as twin studies have produced conflicting evidence.
    
• Age and Sex
  
• • Heaviest drinking is seen in young men in their late teens and early twenties, although the rates in women are increasing quicker.
    
• Occupation
  
• • Harmful drinking greatest in those professions with easy access to alcohol, e.g. barworkers.
    
  • Women in managerial and professional jobs more likely to drink dangerous amounts of alcohol
    
  • Doctors have high rates of dangerous alcohol consumption.
    
• Living in a society where high population levels of consumption
  
• • This is in turn affected by cost and availability
    

 Alcohol Dependence Syndrome:
A person is said to have a Dependence Syndrome if they have three or more of the following six characteristics:

• A strong desire or compulsion to take the substance
  
• Difficulty in limiting or stopping use
  
• Development of tolerance as evinced by the need to take increasing quantities of substance to achieve the same effects
  
• Neglect of other activities and pleasures
  
• Withdrawal symptoms on when substance intake reduced or stopped.
  
• Continued use despite evidence of harmful consequences.
  

  The specific features of alcohol dependence include:

• A stereotyped pattern of drinking – that is drinking the same type of drink at regular intervals.
  
• Relief Drinking – that is drinking to stave off withdrawal symptoms.  Often exemplified by drinking on waking.  In most cultures early morning drinking is diagnostic of dependency.[i]
  
• Decreasing Tolerance in the late stages of dependency due to liver damage.
  
• Reinstatement after abstinence – that is relapsing quickly to old drinking level after period of abstinence.
  

 Alcohol-Related Harm:
Physical Effects

• Neurological
  
• • Epilepsy
    
  • Dementia
    
  • Cerebellar degeneration
    
  • Peripheral Neuropathy
    
• Gastrointestinal
  
• • Oesophageal varices
    
  • Oesophageal carcinoma
    
  • Gastritis
    
  • Peptic Ulcer Disease
    
  • Acute or Chronic Pancreatitis
    
  • Fatty Liver
    
  • Hepatitis
    
  • Cirrhosis
    
  • Hepatocarcinoma.
    
• Others
  
• • Cardiomyopathy
    
  • Anaemia
    
  • Myopathy
    
  • Haemochromatosis.
    

 Neuropsychiatric Effects

• Wernicke’s Encephalopathy
  
• • decreased thiamine intake and impaired absorption and hepatic storage (as a result of alcohol consumption) lead to a deficiency of thiamine.  Additionally alcohol induced liver damage impairs the liver’s ability to convert  any available thiamine to its active form of thiamine pyrophosphate.  Thiamine pyrophosphate is an essential cofactor in glucose metabolism (pentose phosphate pathway and Krebs cycle).  It is thought that  a deficiency of thiamine pyrophospahte leads to altered cerebral energy metabolism, decreased nerve synaptic transmission and impaired DNA synthesis and ultimately brain damage.
    
  • The clinical features are classically a triad of: impairment of consciousness, ataxia and ophthalmoplegia. 
    
• Amnesic Syndrome (Korsokoff’s Syndrome)
  
• • Disorder of recent memory in the absence of generalised intellectual impairment (seen in dementiai) or impairment of consciousness (seen in delirium).
    
  • An organic brain syndrome, caused by permanent brain damage caused thiamine deficiency as above.
    
• Alcoholic dementia
  
• • Direct toxic effect of alcohol on the brain and the secondary effects of liver disease.
    

Psychiatric Effects

• Anxiety
  
• Depression
  
• Deliberate Self Harm
  
• Sexual Dysfunction
  
• Alcoholic Hallucinosis
  
• • Auditory hallucinations in clear consciousness and delusional misinterpretations.
    
  • Is of variable duration and can be chronic.
    

 Effects on Fetus

• Fetal Alcohol Syndrome
  
• • Low intelligence
    
  • Facial abnormality
    
  • Low weight
    
  • Overactivity
    
  • Advise pregnant women to abstain from alcohol!
    

 Social Effects

• Crime
  
• Road Traffic Accidents
  
• Effects on work – absences
  
• Unemployment
  
• Neglect of children
  
• Family Violence.
  

 Alcohol-Withdrawal Syndrome
In dependence the features of withdrawal characteristically appear on waking with the fall in blood alcohol level.  The clinical features of withdrawal include:

• Tremulousness
  
• Agitation
  
• Sweating
  
• Nausea and retching
  
• Misperceptions and hallucinations
  
• Epileptic Seizures
  

 Delirium Tremens is a severe form of withdrawal syndrome with the following clinical features;

• Impairment of recent memory
  
• Disorientation
  
• Clouding of consciousness
  
• Gross tremor of hands
  
• Autonomic Disturbance
  
• Hallucinations
  
• Dehydration and electrolyte disturbance
  

 Delirium Tremens usually lasts 3-4days.  A long-acting benzodiazepine (diazepam or chlordiazepoxide) are first line pharmacological treatment in delirium tremens.
 Treatment of Alcohol Dependence

• Review with patient:
  
• • Extent of alcohol consumption
    
  • Evidence of dependence
    
  • Consequences of harmful level of alcohol consumption.
    
• Withdraw alcohol
  
• • Alcohol is stopped without gradual reduction and long-acting benzodiazepines are used to prevent seizures or delirium tremens and then they are reduced gradually.
    
• Resolve interpersonal problems
  
• Establishing new interests
  
• Maintain abstinence
  
• • Disulfiram (antabuse 100-200mg/day).
    
  • • Acetaldehyde dehydrogenase antagonist.
      
    • Leads to a build up of acetaldehyde which produces a number of unpleasant effects including, headache and flushing.
      
  • Individual counselling.
    
  • Self-help groups e.g.  AA
    

      REFERENCES

http://www.ashesandsnow.org/

(though the merchandise is a bit pricey…)

What a weekend!  It was mid-term break for Glasgow schools on the weekend just past.  On Saturday morning, the alarm clock went off at 6.00am.  My wife said, “We are going somewhere.  You need to pack.”

The birthday surprise!

A taxi arrived at 7 and we set off.  We arrived at Glasgow Airport and they told me I was going to Northern Ireland.  It was nice flying off without warning.  It may seem at times to others that I am a bit disorganised, but I usually know what I am doing and when I am doing it, so there was a bit of uneasiness at being out of control. 

We arrived at Belfast International Airport , which is near to Antrim – quite far from Banbridge (my home-town).  As I waited for the bags to make their way around the carousel, I scanned the arrivals lounge for my dad or any other family member who might be collecting me.  When the bags arrived, my wife said, “Come on.” And made for the exit.  I thought we must be getting a taxi, but as we walked towards the door, she said, “Over here!” and walked towards Eurocar hire. 

After a little bit of a wait, we were given a silver Volkswagen Polo, and she had to tell me we were staying in La Mon House (http://www.lamon.co.uk/).  La Mon House is a famous hotel.  One of the worst atrocities of the troubles took place in it when, in the 1970’s, a terrorist left a bomb in the restaurant. 

It was a lovely hotel.  Really first class.  It is set in the County Down countryside, near to a wee town called Comber.  It isn’t too far out of Belfast either.

The first day we decided to have a scour around and ended up going to Newtownards – a place I used to go to with my family when I was wee.  We ended up seeing the film, Zathura as it was the only family film the boy was interested in (Chicken Little didn’t get very good reviews from his mates).  Zathura was perfect for him.  It was definitely a film made for kids rather than one made on different levels.  It was an adventure story through and through and I think he really liked it.

When we arrived back at the Hotel, a wedding party was in full flight.  After room service, we settled down to bed.  Unfortunately most of the wedding party didn’t and we were kept awake most of the night.  I complained a couple of times and they were told to keep it down – to no avail.  Doors banged all night and people shouted up and down the corridor all night.  We had a chat with the manager the next day and he must have cleared a discount – our bill had £100 knocked off it.

After a huge breakfast, a swim in the pool and a veg in the sauna, we drove to Banbridge and stopped off at my sisters house.  We left the boy off as his cousins were there and went up to my mum and dads. 

Later, everyone said they were going to meet up in the cottage my other sister and her family had rented for the week.  It is really nice – built in stone and furnished beautifully.  We are renting it out next New Year.

When we arrived, there were balloons with my teenaged face on them (the photo used to be my favourite photo in my early teens – it is me wearing a huge pair of aviator style sunglasses and eating a huge ice cream.  It was taken on a family holiday to Ibiza .  They had stuck other photos from my past all around the main room – from early days up until the present.  What I will say is boy, do you see the difference in my physical appearance.  I was a real fit person in my early twenties.  Skinny and wiry.  A couple of years ago I ballooned out.  I was round!  I’m not skinny now, but I have lost a stone since then (1/2 stone since I started this drink project).  Once I start the exercise, I should easily loose another stone.

The cake also had a photo on it – one of me when I was pre-school dressed in a cowboy outfit.  Cool.

I managed to stay off the drink.  I knew this would be a huge hurdle.  The family, including my wife, said things like, “One or two won’t hurt you,” and stuff like that.  I knew if I had taken a drink I couldn’t say I had been off it for six months never mind a year.  I stuck to my guns.  It is all or nothing now.  I will definitely not be drinking until 14^th August this year. 

I was given presents of money, shop vouchers, and a book token and a great curry recipe book.  I still have a present to get from my wife, but she says it is something small.  After a great trip like that, I don’t really expect anything.  I do, however, know it is from Amazon.com as I took the box from the postman when it arrived!

It was a great trip.  I especially like the day we went for a drive around the County Down Coast with my granddad (my dad and my sister and her family travelled in another car).  We went to Portaferry, where we ate in the Portaferry Hotel.  We went across to Strangford on the ferry and stopped off in Ardglass at the harbour.  Our last stop was at the Slieve Donard Hotel (http://tinyurl.com/cws7g) in Newcastle .

I also enjoyed the pool and sauna.  I had good craic with a few blokes who use the health club every day – one of the guys offered to show us the best way to go across Belfast to get to the International Airport .

It has taken six months for me to be able to get the perspective on this project.  I am beginning to appreciate the health aspects and the social life aspects of not drinking.  I am definitely able to do more things and being able to get out of bed without the weekend hangover is fantastic.  Alcohol only does damage, and having read George Best’s autobiography (and recognising some of the signs of problem drinking!) I really would like to live beyond retirement.

The 40^th birthday is on Saturday – I will be able to get by it ok without a drink.  The next crunch comes at the SSP conference in Dundee , though to be honest, I don’t think it will really be much of a challenge.  My wife and I are going to go visiting relatives on the Saturday Evening and perhaps take in a film or a show.  I will try to completely avoid the pub.  I have a speech to make on the Saturday – introducing the motion on a ban on smacking children.  It is going to be tough, but I think sense will prevail and it will be passed – though socialists are, believe it or not, a cautious bunch.

I’m still 39, by the way.  And will be until Saturday.  After that I won’t be having any more birthdays…

http://tinyurl.co.uk/yhpk

http://tinyurl.co.uk/x9e9

http://tinyurl.co.uk/u5hs

http://tinyurl.co.uk/g2wq