ALCOHOL USE

Background

 
Although alcohol consumption has fallen since the late 1970's, Australians are still relatively big drinkers and spend over $700 each per year on alcohol. 60% of us drink at least once a week and @ 10% of us drink daily. Approximately, one third of young people between the ages of 14 and 19 consume 5 drinks or more in one session every two weeks. In the 2009-2010 financial year, the estimated total cost of alcohol misuse in Australia was $36 billion!!

What is a safe drinking level?

 
Alcohol is part of our way of life in Australia and is not a cause of ill health when used in moderation. However, excessive alcohol consumption is a major cause of physical ill-health as well as social and emotional problems.
 
There are two patterns of drinking that cause harm: bingeing (drinking more than 5 drinks in a short time such as 1 - 2 hours). 
 
Regular excessive drinking (see Table below) can result in damage to many body organs, especially the liver. The National Health and Medical Research Council (NHMRC) advises that men consume less than 4 standard drinks (40g alcohol) per day and women less than 2 standard drinks (20g alcohol) per day (Tables 1 and 2). 
 
Women are more susceptible to damage from alcohol than men because they break alcohol down (metabolise it) more slowly. 
 
These recommendations are supported by a number of other bodies including the National Heart Foundation and the Australian Medical Association.
 

TABLE 1: GUIDELINES FOR RESPONSIBLE DRINKING

 
 
 
Males alcohol/day
Females alcohol/day
Low risk drinking
up to 40g
up to 20g
Hazardous drinking
40-60g
20-40g
Harmful drinking
over 60g
over 40g
 

TABLE 2: WHAT IS A STANDARD DRINK

 
 
 
Strength By Volume
Size (Volume)
Amount
Standard Drinks
Low Alcohol Beer
about 2-3%
375ml
(1 can)
10g
1
Regular Beer
about 4-5%
375ml
14-15g
1.5
Red or White Table Wine
10-14%
750ml
(1 bottle)
60-80g
6-8
Fortified Wine (e.g. port, sherry)
18%
60ml
10g
1
Spirits (e.g. gin, whisky)
38%-48%
30ml
(nip)
10g
1
 

Why do some people drink too much?

 
The use of alcohol is very much a part of the Australian way of life and is actually encouraged by peer pressure and advertising. Many people use alcohol to change how they feel about themselves and about life and for some with a strong family history of alcohol dependence, genetic factors can influence drinking patterns. Once excessive alcohol use has become a habit, this behaviour can develop its own momentum.
 

What effect does alcohol have on the body?

 
(1) Intoxication (getting drunk)
 
The immediate effects of alcohol depend upon the amount of alcohol in the blood and whether the person is an experienced drinker. As the blood alcohol rises, drinkers feel more relaxed and are often more talkative. They become less aware of their behaviour and judgement is often impaired. Loss of co-ordination and drowsiness may occur. The risk of accidents rises, particularly for those involved in operating machinery and driving cars. An individual with a blood alcohol level of 0.05 has twice the risk of having a motor vehicle accident as one with a blood alcohol level of zero.
 
(2) Long term effects 
 
Alcohol Dependence (addiction)

 
Tolerance - Ability to drink progressively larger amounts without apparent intoxication.
 
Withdrawal - Anxiety, agitation, confusion, shakes, fits etc which occur when alcohol consumption is suddenly stopped.
 
Alcohol seeking behaviour - Craving, continuing to drink despite adverse effects.
 
Medical Liver disease - Liver inflammation and fat deposition. These may progress to liver failure. Cirrhosis (scarring)
 
Stomach and bowel diseases -
Heartburn and indigestion due to an inflamed gullet (reflux) or stomach (gastritis).
Diarrhoea. Inflammation of the pancreas (pancreatitis) leading to abdominal pain or inability to absorb food.
Cancer of the liver, gullet, bowel.
 
Brain damage - Memory loss and difficulty learning (dementia)
Poor co-ordination and balance.
 
Other neurological diseases - Damage to nerves, leading to numbness in the legs and difficulty walking.
 
Heart & blood vessel diseases -
Heart failure (leading to shortness of breath and ankle swelling)
Palpitations / High blood pressure (hypertension)
 
Sexual & reproductive disorders - Damage to the testicles leading to impotence Damage to the unborn baby (foetal alcohol syndrome).
 
Bone & joint disorders -
Gout (painful swelling of the joints, most commonly the big toe)
Osteoporosis - thinning of the bones which may lead to fractures (broken bones)
 
Accidents -
Head injury
Blood clots around the brain
Broken bones (especially the ribs)
Road accidents
Accidents at work or home 
 
Nutrition -
Malnutrition
Obesity 
 
Other - Interactions with other drugs e.g. drugs used to treat epilepsy.
 
Psychological
Difficulty sleeping
Anxiety and agitation
Depression and inability to cope
Confusion and panic attacks
Alcoholic 'blackouts'
Suicide  
 
Social
 
Domestic problems -
Loss of friends
Difficulties in marriage or other significant relationships
Separation and divorce
Neglect of children 
 
Occupational -
Lateness or absences from work
Demotion/failure to gain promotion
 
Financial problems -
Loss of regular income from employment. Hardship because of money spent on alcohol
Gambling debts
 
Legal problems -
Drink-driving offences/loss of licence
Property crime
Assault
Homicide

 
Alcohol dependence is indicated by evidence of tolerance and/or symptoms of withdrawal upon cessation of drinking.

Alcohol abuse is characterized by recurrent performance problems on the job or at school that result either from the after effects of drinking alcohol or from actual intoxication on the job or at school.
 
People with alcohol abuse disorders often continue to consume alcohol despite the knowledge that continued use causes significant social or interpersonal problems for them. And people with alcohol use disorders often consume alcohol despite knowing that they suffer from alcohol-related medical problems such as liver disease.

 

Prevention

Prohibition of any drug including alcohol has been shown to do nothing to reduce the harm caused by that drug and may actually make matters worse. Alcohol can be part of a healthy lifestyle if it is used In moderation. Table 4 contains some tips to help reduce harm.
 

Drinking Tips to Reduce HarmAlcohol Effects

  • Don't drink alcohol to quench your thirst.
  • Use spacers (alcohol free drinks) between alcoholic drinks to prevent excessive alcohol consumption.
  • Drink low alcohol beverages.
  • Count your drinks, keeping within the recommended guidelines
  • Don't refill your glass until it is empty.
  • Don't gulp drinks. Take smaller sips.
  • Eat before drinking. Your drink will take longer to be absorbed.
  • Don't drink if you are pregnant. It may damage the health of your unborn child.
  • Don't drink if you are operating machinery, you put your fellow workers as well as yourself at risk.
  • If you are a regular drinker, have at least two alcohol-free days each week.
  • Don't drink to cope with stress.
    Exercise, relaxation, meditation or talking to friends are safer ways of coping.

Treatment

 
Alcohol abuse is an extremely complex issue and often requires a range of treatments. Any behaviour change is difficult, whether it is changing diet, giving up smoking, starting an exercise regime or modifying drinking habits and often many attempts are needed to succeed.
 
The first step in treatment is the recognition by the person that drinking could be causing harm - both to themselves and to people around them. Fortunately today, there are many choices available in regard to treatment.
 
Options range from complete abstinence (for people with a severe drinking problem) to controlled drinking where people learn what triggers excessive drinking and how to change their response to these triggers and thereby moderate their drinking.
 

Where to access treatment on the Gold Coast

 
A good place to start is to talk to your General Practitioner. He or she can advise you where to go according to what your individual goals and needs are. 
 
Here are some of the services available on the Gold Coast:-
 
ATODS - (alcohol, tobacco and other drug service) – Gold Coast Hospital, 108 Nerang St, Southport. Ph: 07 5571 8777. Provides free individual and family counselling.
 
ALCOHOLICS ANONYMOUS - Central service office is at the Community Centre, Lawson St, Southport. Ph: 07 5591 2062. There are daily meetings all over the Gold Coast to provide support for people who choose to abstain from alcohol. AA is a 12 step programme of recovery.

AL ANON Family groups Ph: 07 5532 4320. Provide information and support for people living with someone who has an alcohol problem
 
FAIRHAVEN ASSESSMENT AND ADMISSIONS OFFICE – Provide short term detoxification for people wanting to withdraw from alcohol and longer term rehabilitation services. Introduction to the 12 step programme of AA. Contact details: 4 Scarborough Street, Southport Ph: 07 5630 7939    Fairhaven website  Rehabilitation located at Eagle Heights, Gold Coast
  
PALM BEACH CURRUMBIN PRIVATE CLINIC 37 Bilinga St, Currumbin. Ph: 07 5534 4944 or 1800 819 851. Private psychiatric clinic providing detox and treatment for people with drug and alcohol problems. Included is group therapy and introduction to AA and the 12 step programme.
 
MIRAKAI - West Burleigh Rd, Burleigh Heads. Ph: 07 5535 4302 – provide a long term residential treatment programme for young people with drug and alcohol problems – 15 to 29yrs. Also offer telephone counselling; out client groups; family therapy; drug diversion initiatives and community awareness education courses.
 
LIFELINE Crisis Counselling service2741 Gold Coast Hwy, Broadbeach. Ph: 13 1114. Provide support, information and referral.
 
INDIVIDUAL COUNSELLING SERVICES - there are many Psychiatrists and psychologists on the Gold Coast who provide counselling for drug and alcohol problems. For more information, phone The Cottage at Gold Coast Hospital. Ph: 07 5571 8211.
 
CROSSROADS RECOVERY ASSOCIATION INC8 High St, Southport. Ph: 07 5531 4161. Provides a drug and alcohol counselling service to young people and their families; information and discussion evenings. This is a self funded service. Donations welcome.
 

Other related services:

 
YES HOUSE Youth Health & Education Service Inc – 101 Nerang St, Southport. Ph: 07 5531 1577. For young people (12-25years) -provides a medical service; support and counselling; educational groups and workshops; advocacy, information and referral.
 
GOLD COAST YOUTH SERVICE15 Oak Ave, Miami. Ph: 07 5572 0400 – For young people (12 – 25 years) - provides assistance with accommodation; referrals and advocacy; counselling and support; workshops and programmes; information and advice.
 

 

ALCOHOLIC LIVER DISEASE

Alcoholic liver disease occurs after prolonged heavy drinking, typically for at least 10 years and particularly among those who are physically dependent on alcohol. However, not everyone who drinks alcohol to excess develops serious forms of alcoholic liver disease. It is likely that genetic factors determine this and a family history of cirrhosis may indicate a higher risk. Other factors include being overweight and iron overload (see section on Haemochromatosis). Women are more susceptible to alcoholic liver disease than men.
 
Liver problems caused by alcohol include:
 
Fatty Liver
Alcoholic Hepatitis
Alcoholic Cirrhosis
 
(1) Fatty Liver
 
This may occur in people who drink 30g or more of alcohol each day (see section on Fatty liver for more detailed information.) Alcohol abuse can lead to the accumulation of fat within the liver cells. Management includes reducing alcohol intake and weight loss. Alcohol dependence needs to be recognized and dealt with. Fatty liver can lead to inflammation and eventually scarring of the liver and cirrhosis.
 
(2) Alcoholic hepatitisAlcohol Stages
 
Excessive use of alcohol can cause acute and chronic hepatitis (inflammation of the liver). Usually occurs in someone who is a chronic drinker with a recent episode of prolonged heavy consumption.
 
Alcoholic hepatitis can range from a mild hepatitis to severe liver problems with symptoms of jaundice (yellow skin), mental confusion caused by liver failure, ascites (fluid retention in the abdomen), bleeding oesophageal varices (varicose veins in the oesophagus), abnormal blood clotting and coma.
 
Alcoholic hepatitis is reversible if the person stops drinking but it can take several months for reversal to occur. Alcoholic hepatitis can lead to liver scarring and cirrhosis and very frequently occurs in alcoholics who already have cirrhosis of the liver.

(3) Cirrhosis
 
Anything which results in severe liver injury can cause cirrhosis. Common causes include excessive alcohol intake, chronic hepatitis B and C infection, intake of certain chemicals and poisons, too much iron or copper, severe reaction to drugs and obstruction of the bile duct.
Cirrhosis of the liver is a degenerative disease where liver cells are damaged and replaced by scar formation.
 
As scar tissue progressively accumulates, blood flow through the liver is diminished, causing even more liver cells to die. Loss of liver function can result in disturbances in important liver functions such as the processing of nutrients, hormones, and the detoxification of drugs and poisons including alcohol.
 
In more advanced liver disease there can be enlargement of the liver and spleen, jaundice and accumulation of fluid in the abdomen and other tissues of the body. Blood clotting can be impaired and this can lead to internal bleeding.
 
Some types of cirrhosis can be treated but often there is no cure. At this point, treatment is mostly supportive and may include adherence to a special diet, diuretics (fluid tablets) and abstinence from alcohol. If the cirrhosis has been caused by a virus such as hepatitis C, some people can undergo HCV treatment which may reduce the chance of progression to more advanced liver disease.
 
Although cirrhosis is not reversible, people who stop drinking may avoid progression to liver failure and/or liver cancer.
 
Treatment 
 
Some types of cirrhosis can be treated but often there is no cure. At this point, treatment is mostly supportive and may include adherence to a special diet, diuretics (fluid tablets) and abstinence from alcohol. Although cirrhosis in general is not reversible, people who stop drinking may avoid progression to liver failure and/or liver cancer. 

 
For more information see the section on Cirrhosis.
 

For Treatment services on the Gold Coast: See section on Alcohol

Acknowlegements:
 
• “Hepatitis C, other liver disorders and liver health” – a practical guide, by Geoffrey C Farrell

• “Alcoholic Liver Disease” by Howard J. Worman M.D