RCSI Psych Specific Behaviours Alcohol 2024 Bahrain PDF

RCSI Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn Specific Behaviours: Alcohol use Class MED2 Bahrain Module GI-HEP Title Lifestyle Medicine: Alcohol use Enter subtitle here (24pt, Arial Regular) Lecturer Dr Sally Doherty Date E...

RCSI Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn Specific Behaviours: Alcohol use Class MED2 Bahrain Module GI-HEP Title Lifestyle Medicine: Alcohol use Enter subtitle here (24pt, Arial Regular) Lecturer Dr Sally Doherty Date Enter 2024 date: 25.06.13  Case: Maria Maria is a 32-yr-old woman who has presented requesting help to reduce her drinking. She says she has been drinking wine every night after work over the past year. She says that sometimes she opens a bottle intending to have only one glass, but ends up finishing the bottle with her partner. This used to only happen at the weekends, but is now happening 3-4 times per week. She now always finishes the bottle on weekend nights and often during the week also. She says she usually has a little more of the bottle than her partner as she would be the one to finish the remainder more often. On weekend nights they might open a second bottle where she would have 1-2 more large glasses. She reports feeling hungover in the mornings and is never tempted to drink before evening time. She began to feel guilty about it as her mother recently visited her but found she was drunk and they had a row about it. How would you assess Maria? Alcohol: Learning outcomes Summarise patterns of drinking Apply assessment of drinking units and alcohol use disorder Outline the associated risks of alcohol use/abuse Summarise correlates of binge drinking and dependence Apply the principles of assessment of problem drinking Summarise two approaches to treatment and prevention Key facts – WHO 2024 Alcohol and alcoholic beverages contain ethanol, which is a psychoactive and toxic substance with dependence-producing properties. Alcohol has been widely used in many cultures for centuries, but it is associated with significant health risks and harms. Worldwide, 2.6 million deaths were attributable to alcohol consumption in 2019, of which 2 million were among men and 0.6 million among women. The highest levels of alcohol-related deaths per 100 000 persons are observed in the WHO European and African Regions with 52.9 deaths and 52.2 deaths per 100 000 people, respectively. People of younger age (20–39 years) are disproportionately affected by alcohol consumption with the highest proportion (13%) of alcohol- attributable deaths occurring within this age group in 2019. https://www.who.int/news-room/fact- sheets/detail/alcohol#:~:text=Health%20risks%20of%20alcohol%20use&text=Drinking%20alcohol%20is%20assoc iated%20with,anxiety%20and%20alcohol%20use%20disorders. https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol/medical-complications- common-alcohol-related-concerns Summarise patterns of drinking AFR African Region / EUR European region/ SEAR South East Asian region WPR Western specific region / AMR Region of Americas / EMR Eastern Mediterranean region https://iris.who.int/bitstream/handle/10665/377960/9789240096745- eng.pdf?sequence=1 Analysis of youth trends across Europe Youth alcohol consumption has generally been declining across participating EU countries since the early 2000s, except for binge drinking, which has increased. This is an important finding, given that binge drinking in adolescence is associated with acute health issues such as road traffic accidents, violent behaviour, risky sexual activity and teenage pregnancy https://health.ec.europa.eu/document/download/19d39fd6-9455-4e99-a009- 3808f8a18be6_en?filename=2018_hepp_casestudyyouthalcoholtrends_en.pdf  Global Burden of Disease: By age/region Lancet 2022; 400: 185–235 What is a safe level of alcohol consumption? Safe Levels of Consumption (per week)* Men Women 21 units (WHO) 14 units (WHO) 17 (Ireland) 11 (Ireland) 1 pint (normal strength) = 2 units, 1 bottle wine = 8 units, “alco-pops” = 1.5 units, 1 whiskey = 1 unit Binge drinking can be defined as 6 units or more (WHO) Definitions are disputed Grammes of alcohol: UK = 8g, Irish = 10g, Japan = 19.75g! http://www.hse.ie/eng/services/healthpromotion/alcohol/ http://www.yourdrinking.ie/about-alcohol/what-is-a-standard-drink/  Ireland: drinking patterns - 2022 ~67% of the Irish population (>15yrs) drank alcohol within past 6 months, of these: – Small gender difference – with 55% at least weekly – 32% multiple times per week – Men more likely to binge: 35% v 10% => 22% of the overall population are binge drinkers – Reduced from 28% in 2018 13% of those who binge report that children Excessive bingeing leads to alcohol dependence Psychology & Health, 32:8, 976-1017, DOI: 10.1080/08870446.2017.1325889  Alcohol use disorders (AUD): DSM-5 DSM-5: Single construct: distinguished on number of criteria Mild = 2-3 criteria; Moderate=4-5 criteria; Severe = 6+ criteria Recurrent use resulting in failure Drinking in larger amounts or for to fulfil obligations longer than intended Recurrent use resulting in Persistent desire or unsuccessful hazardous situations attempts to stop/reduce drinking Continued use despite alcohol- Great deal of time spent related social or interpersonal obtaining, using, or recovering problems from alcohol Tolerance Important activities given Withdrawal or substance use for up/reduced because of drinking relief/avoidance of withdrawal Continued drinking despite Alcohol craving knowledge of physical or psychological problems caused by alcohol Lancet Psychiatry 2016; 3: 673–84  Dangers of alcohol abuse  Alcohol consumption is associated with... 6% of global deaths 80% of suicides 50% of murders 80% of deaths from fire 40% of road traffic accidents 30% of fatal road traffic accidents 15% of drownings 1/3 divorces 1/3 cases of child abuse 20-30% of all hospital admissions BMJ 315:353-60; BMJ 2015;350:h715 doi: 10.1136/bmj.h715  Alcohol causally related to… Cancer Infectious diseases – 4-5% attributable – TB, HIV, pneumonia CVD and Diabetes – Compromised immune – Complex system Neuropsychiatric Maternal and perinatal conditions conditions – AUDs, epilepsy – Foetal Alcohol Spectrum – Depression/anxiety? Disorder Gastrointestinal conditions Unintentional injuries – Fatty liver, liver cirrhosis Intentional injuries – Pancreatic disease Mongan, D., and Long, J., Health Research Board (HRB). (2016) Alcohol in Ireland: consumption harm cost and policy response [Online]. Available from: http://www.thehealthwell.info/node/1005983 [Accessed: 6th September 2016].  Alcohol and all-cause mortality Use to be believed that moderate consumption was protective for cardiovascular health This does not appear to be the case GBD 2016 Alcohol Collaborators: dx.doi.org/10.1016/S0140-6736(18)31310-2  Risks of alcohol use and abuse Single occasions (binge drinking) Accidents, falls, drowning, fires, Regular heavy drinking disability, alcohol poisoning, death. Liver cirrhosis Hangovers, blackouts, memory Acute pancreatitis loss, nausea Irreversible neurological and vomiting damage Academic/educational impairment: Increased risk of cardiovascular missed classes, falling behind on disease and some cancers (oral, work, lower grades breast, liver, colon, stomach) Domestic and other violence as Alcohol dependence perpetrator and/or victim (including Exacerbation of psychological sexual assaults); self-harm, and social problems homicide, suicide Foetal alcohol syndrome Unwanted pregnancies, HIV and other STIs Social, health, legal and economic costs BMJ 2015;350:h715 doi: 10.1136/bmj.h715 Psychology & Health, 32:8, 976-1017, DOI: 10.1080/08870446.2017.1325889  Correlates of alcohol use and dependence Discussion Why do we drink alcohol? Why do some people become alcohol dependent? Learning theories Operant conditioning: – Personal, social and physiological rewards – Normal drinking becomes problem drinking due to reinforcement – Gradient of reinforcement: reinforcement occurring rapidly (reduced anxiety) much more effective than delayed reinforcement (hangover) Social learning theory: – Self-efficacy (confidence) – Learning by imitation - imitate parents, peers? – Expectancies? Account for only 1-3% of frequency of drinking! Addiction 2001;96, 57– 72  Correlates of binge drinking: personal, social Personality Parents Extroversion Genetics, role-modelling, impulsivity, disinhibition and social learning sensation/novelty-seeking ↓ if provide both boundaries Greater sensitivity to alcohol- & empathy, and monitor their related cues activities/whereabouts Self-medication/Coping ↑ if authoritarian/neglectful Stress, trauma, depression Peers etc. Higher social status for Negative reinforcement bingeing Motives/expectancies Friendship quality Environment, culture and advertising Psychology & Health, 32:8, 976-1017, DOI: 10.1080/08870446.2017.1325889 Dependence: Genetic versus Environmental theories Are people “born Addiction theories started alcoholics”? with Temperance DNA variations movement in 19th associated with century: “demon drink” metabolism of alcohol – everyone at risk - Biological determinism alcohol highly Alcoholics Anonymous addictive philosophy Supported by drinks industry - why? https://www.learning-history.com/prohibition-united-states/  Current thinking http://pubs.niaaa.nih.gov/publications/Social/Module2Etiology&NaturalHistory/Module2.html Epigenetics: Current thinking about alcohol dependence Assessment  Recognising potential problem drinking Presents with: – Relevant physical conditions (liver disease, gastrointestinal problems, hypertension) – Social problems: Marital, sexual, domestic or other violence or injuries, work difficulties, legal/financial problems Psychiatric problems – Irritability/rage states, anxiety, depression, insomnia, repeated accidents or trauma, decline in usual standards of social concern and personal care History of doctor-shopping – Frequent consultations with different doctors – Simply requests medications or medical certificate BMJ 2015;350:h715 doi: 10.1136/bmj.h715  Recognising problem drinking >20% of patients presenting in primary care are higher risk or dependent drinkers – Arch Intern Med. 1998;158:1789-1795 AUDIT-C Arch Intern Med. 1998;158:1789-1795 Prevention & Treatment Brief interventions Advice on consumption reduction 1. Raise the problem: Qs1-3 on AUDIT, >4 then administer remaining AUDIT questions 2. Score 0-7: Provide information about alcohol effects Score 8-19 – offer brief advice 3. Deliver structured brief advice – “how important is it for you to change your drinking?” – How confident, between 1 and 10, do you feel in making changes? – what would have to happen to make the number go up? Scores of 20-40 need specialist assessment N Engl J Med 2013;368:365-73; BMJ 2015;350:h715 doi: 10.1136/bmj.h715  5As for alcohol Should do…. Detail Ask Ask all patients Advise Brief advice on health effects (non- judgemental) Assess Readiness to change, AUDIT score (Wheel/Stages of change) Assist Strategies for reduction Arrange follow-up Further support https://www.youtube.com/watch?v=b-ilxvHZJDc https://www.youtube.com/watch?v=KRu5uMwSkQg (Bad v good example, plus an exit strategy) How effective do you think brief advice is? Poll: 1. Most people will reduce their drinking 2. About 1 in 2 people will reduce drinking 3. Around 1 in 8 people will reduce their drinking 4. It is so few it is better to rely on medication Brief interventions and other treatments 1/8 of higher risk drinkers will reduce drinking after receiving brief advice – Little evidence that inpatient/outpatient care is more effective – AUDIT screening scores should be revised downwards if patients are >65 or