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Conversations at The Royal - Alcohol: How much is too much?

Are you drinking TOO much?

Alcohol is the most commonly used potentially addictive substance in our society. Alcohol is responsible for over half of the $267 million dollars of substance related hospital costs in Canada. Problematic alcohol use significantly impacts individuals, families, and our community, but many struggle to know if they have a problem and where to go for help.

Learn more: http://www.theroyal.ca/mental-health-centre/news-and-events/newsroom/13411/alcohol-how-much-is-too-much/

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Conversations at The Royal - Alcohol: How much is too much?

  1. 1. Conversations at the Royal Alcohol: How Much is Too Much? Dr. Kim Corace, Director Program Development & Research Dr. Melanie Willows, Clinical Director Substance Use and Concurrent Disorders Program November 19, 2015
  2. 2. Outline/Learning Points • How to tell if you or a loved one has a problem with alcohol • The relationship between alcohol use and mental health disorders • Treatment options for alcohol use disorders, including where to seek help
  3. 3. Who has an alcohol problem? • 55 year old homeless man drinking hard liquor from morning to night • 39 year old woman executive drinking 1 litre of wine every night after work • 25 year old man who binges every weekend has had 2 impaired driving charges and has lost several jobs for not showing up
  4. 4. The total societal cost of alcohol abuse in Canada is estimated to be $14.6 billion or $463 for every Canadian *The Costs of Substance Abuse in Canada 2002 (Rehm et al., 2006)
  5. 5. Source: CCSA, 2014
  6. 6. Source: CCSA, 2014
  7. 7. Source: CCSA, 2014
  8. 8. Most people in need of treatment for alcohol use problems do not get it
  9. 9. WHAT IS “NORMAL” DRINKING?
  10. 10. 341 ml (12 oz.) bottle of 5% alcohol beer, cider or cooler 142 ml (5 oz.) glass of 12% alcohol wine 43 ml (1.5 oz.) serving of 40% distilled What is “One Standard Drink”? (equivalent to 13.6 grams of alcohol)
  11. 11. Calculating How Much I am Drinking • Wine – 750ml bottle = 5 standard drinks – 1 L bottle = approx. 8 standard drinks – 1.5 L bottle = 10 standard drinks • Beer – Size? 341ml, 355ml, 473ml, 500ml, 600ml, 710ml • Hard Liquor – 13 oz (mickey) 375ml = 8 standard drinks – 26 oz bottle 750ml = 17 standard drinks – 40 oz bottle 1140ml = 26 standard drinks
  12. 12. Canadian Guidelines for Low Risk Drinking* Recommendation 1 • Reduce your long-term health risks by drinking no more than: • 10 drinks a week for women, with no more than 2 drinks a day most days • 15 drinks a week for men, with no more than 3 drinks a day most days • Plan non-drinking days every week to avoid developing a habit. **Guidelines are intended for individuals 25 to 65
  13. 13. Canadian Guidelines for Low Risk Drinking Recommendation 2 • Reduce your risk of injury and harm by drinking no more than 3 drinks (for women) and 4 drinks (for men) on any single occasion.
  14. 14. Canadian Guidelines for Low Risk Drinking Recommendation 3 Do not drink when you are: – driving a vehicle or using machinery and tools – taking medicine or other drugs that interact with alcohol – doing any kind of dangerous physical activity – living with mental or physical health problems – living with alcohol dependence – responsible for the safety of others – making important decisions
  15. 15. Canadian Guidelines for Low Risk Drinking Recommendation 4 If you are pregnant, planning to become pregnant, or before breastfeeding, the safest choice is to drink no alcohol at all.
  16. 16. Canadian Guidelines for Low Risk Drinking Recommendation 5 If you are a child or youth, you should: • Delay drinking until your late teens • Talk with your parents about drinking. Alcohol can harm the way your brain and body develop. • If you are drinking, plan ahead, follow local alcohol laws and stay within the limits outlined in Guideline 1
  17. 17. HOW MUCH IS EVERYBODY ELSE DRINKING?
  18. 18. Past Year Drug Use (%) for the Total Sample, and by Sex and Grade, 2013 OSDUHS (CAMH) Total Male Female G7 G8 G9 G10 G11 G12 Alcohol 49.5 49.8 49.1 9.9 24.6 37.1 53.5 67.9 74.4 Cannabis 23.0 25.3 20.6 1.7 7.0 14.6 24.5 33.5 39.2 Binge Drinking 19.8 21.3 18.3 3.7 8.5 18.1 29.5 39.2 Opioid Pain Relievers (NM) 12.4 12.8 12.0 8.8 8.9 11.8 13.0 12.1 16.1 Cigarettes 8.5 9.6 7.3 3.3 9.1 12.9 15.4
  19. 19. Canadian Alcohol and Drug Use Monitoring Survey 2012 (CADUMS) Pattern of Drinking Percent Reporting Exceed chronic guideline (>10 drinks per week or more than 2 drinks per occasion for women or >15 drinks per week or more than 3 drinks per occasion for men) 9.2% Exceed acute guideline (3 or more per occasion for women or 4 or more per occasion for men) 14.4% Past year any consumption of alcohol 78.4% Youth (15-24) rates exceeds adults Males rates exceed Females
  20. 20. HARMFUL EFFECTS OF ALCOHOL
  21. 21. Effects of Drinking Alcohol • Impaired thinking and judgement • Speech • Vision • Balance • Co-ordination • High blood levels of alcohol can cause your breathing rate and heart rate to decrease and may even cause death in nontolerant individuals
  22. 22. Binge Drinking • Definition – MEN: consuming 5 or more drinks on any one occasion – WOMEN: consuming 4 or more drinks on any one occasion • OSDUHS study of high school students: – No gender differences in binge drinking; – 18% of students could not remember what had happened while they were drinking on at least 1 occasion (last month); – 8% report that they or someone else was injured as a result of their drinking; – 4% of drivers (grade 10-12) report driving after consuming 2 or more drinks
  23. 23. Risks of Binge Drinking • Addiction • Problems in school, relationships, work • Injuries • Legal issues • Sexually transmitted infections • Unintended pregnancy • Breast cancer, heart disease • Death (accident, overdose)
  24. 24. ALCOHOL WITHDRAWAL IS A MEDICAL ISSUE: IT IS POTENTIALLY LIFE THREATENING
  25. 25. What is Alcohol Withdrawal? • Occurs within 4 to 12 hours after last drink • Most severe symptoms peak 48 to 72 hours after last drink • Withdrawal symptoms typically improve by the 5th day • Most common symptoms: elevated blood pressure, sweating, hand tremor, anxiety, difficulty sleeping • Potentially life threatening with more serious symptoms: seizures, delirium, elevated blood pressure and heart rate
  26. 26. Could you be at risk of serious alcohol withdrawal? • Previous history of alcohol withdrawal seizures • Previous history of delirium tremens • Daily drinking more than 6 drinks per day • Drinking throughout the day • Unsuccessful attempts to stop drinking for more than two or three days • Previously required medication to withdraw from alcohol • Previously sent to ER for alcohol withdrawal management • Cirrhosis of the liver (advanced liver disease) 26
  27. 27. Can alcohol withdrawal be treated? • Yes! • The serious complications of alcohol are preventable with “medical withdrawal management” • There are medications that can help. • Talk to your doctor or nurse practitioner to help you
  28. 28. HOW DO I KNOW IF I MIGHT HAVE A PROBLEM?
  29. 29. Alcohol Use Disorders Identification Test (AUDIT; Saunders et al., 1993) 1. How often do you have a drink containing alcohol? Never (0) Monthly or less (1) 2 to 4 times a month (2) 2 to 3 times per week (3) 4 or more times per week (4) 2. How many drinks containing alcohol do you have on a typical day when drinking? 1 or 2 3 or 4 5 or 6 7 to 9 10 or more 3. How often do you have six or more drinks on one occasion? Never Less than monthly Monthly Weekly Daily or Almost daily 4. How often during the last year have you found that you were not able to stop drinking once you had started? Never Less than monthly Monthly Weekly Daily or Almost daily 5. How often in the last year have you failed to do what was normally expected from you because of drinking? Never Less than monthly Monthly 2 to 3 times per week 4 or more times per week
  30. 30. 6. How often during the past year have you had a drink in the morning to get yourself going after a heavy drinking session? Never (0) Less than monthly (1) Monthly (2) Weekly (3) Daily or almost daily (4) 7. How often during the last year have you had a feeling of guilt or remorse after drinking? Never Less than monthly Monthly Weekly Daily or almost daily 8. How often during the last year have you been unable to remember what happened the day before because of drinking? Never Less than monthly Monthly Weekly Daily or almost daily 9. Have you or someone else been injured because of your drinking? Never Yes, but not in the last year Yes, during the last year 10. Has a relative, friend, doctor, or other health care worker been concerned about your drinking or suggested you cut down? Never Yes, but not in the last year Yes, during the last year
  31. 31. AUDIT: What does my score mean? • Score of 8 or more: harmful/hazardous drinking • Score of 13 or more in women; 15 or more in men indicates likely alcohol dependence *This is just a screening tool, so be cautious when interpreting your score. If you have any concerns, talk to your doctor, nurse, or a health professional.
  32. 32. Ottawa Public Health: Check Your Drinking http://www2.checkyourdrinking.net/
  33. 33. WHAT ABOUT ADDICTION?
  34. 34. Addiction is a developmental disease that starts in adolescence and childhood1 1NESARC , 2003
  35. 35. Addiction is a Disease • Primary, chronic disease of brain reward, motivation, memory and related circuitry • Characterized by inability to consistently abstain, impairment in behavioural control, craving, diminished recognition of significant problems with one’s behaviours and interpersonal relationships, and a dysfunctional emotional response ASAM, 2011
  36. 36. What is addiction? • Like other chronic diseases, addiction often involves cycles of relapse and remission • Addiction is progressive and can result in disability or premature death ASAM, 2011
  37. 37. The “4 C’s” of Addiction • CRAVING • Loss of CONTROL • Use despite CONSEQUENCES • COMPULSIVITY
  38. 38. Alcohol Use Disorder* is a Mental Health Disorder • A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12 month period. • Criteria fit within the overall groupings of: – Impaired Control (criteria 1-4) – Social Impairment (criteria 5-7) – Risky Use (criteria 8-9) – Pharmacological (criteria 10-11) *DSM-V
  39. 39. Risk Factors for Substance Use Problems ADDICTION Vulnerable Host Environment/ Sociocultural Context Repeated substance use
  40. 40. IS THERE A RELATIONSHIP BETWEEN ALCOHOL PROBLEMS AND MENTAL HEALTH PROBLEMS?
  41. 41. Concurrent Disorders Mental Health Disorder + Substance Use Disorder + Physical Health Disorder _____________________________________________________ Concurrent Disorder
  42. 42. Concurrent Disorders are the Norm • People with alcohol use problems have higher rates of mental health problems than the general population • People with mental health problems have higher rates of alcohol use problems than the general population • 37% of people with an alcohol use disorder will have a mental health disorder at some time in their lives1 1Epidemiological Catchment Area study
  43. 43. Lifetime Comorbidity of Mental Health Disorders and Alcohol Dependence Mental health disorder Individuals With Alcohol Dependence Men Women % Odds Ratio % Odds Ratio Anxiety 35.8 2.2 60.7 3.1 Mood 28.1 3.2 53.5 4.4 National Comorbidity Survey (Kessler, et al, 1997)
  44. 44. Concurrent Treatment is Key • Treating both mental health and alcohol use problems together = Greater chance of success • If mental health and alcohol use problems are caught and treated early, people have a better chance of a quicker and fuller recovery
  45. 45. IF I THINK I (OR MY LOVED ONE) HAS A PROBLEM, WHAT CAN I DO?
  46. 46. Stages of Change Contemplation Pre- Contemplation Preparation Maintenance
  47. 47. Safer Drinking Tips • Set limits for yourself and stick to them • Drink slowly. Have no more than 2 drinks in any 3 hours. • For every drink of alcohol have one non-alcoholic drink. • Eat before and while you are drinking. • Always consider your age, body weight and health problems that might suggest lower limits • Reducing risk of harm (i.e. drinking and driving) • Gradual reduction to lower level of drinking, with potential to work towards a safer quit attempt
  48. 48. What treatments are available? • There are many treatment options available to help: – Withdrawal Management – Medication – Psychotherapy (“Talk therapy”) – Mental Health Treatment – Physical Health Treatment – Self-help groups – Community or hospital based; residential treatment • Treatments are not “one size fits all • Talk to your doctor or nurse practitioner to get started
  49. 49. • Family Doctor or Nurse Practitioner • The Royal’s Substance Use and Concurrent Disorders Program • Ottawa Withdrawal Management Centre • OAARS: Ottawa Addiction Assessment and Referral Service • Self Help Meetings: AA, SMART Recovery What services are available in Ottawa?
  50. 50. What are the resources for families? • The Royal – Family Information Sessions – Wednesday evenings information session from 6-8pm at 1145 Carling Avenue, option to attend via OTN – Next one is December 2nd, 2015 • Family Groups: Al-anon; Al-ateen • Rideauwood Addictions and Family Services – Family Member Program provides education, crisis support and counselling • Serenity Renewal • Family Doctor or Nurse Practitioner

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Are you drinking TOO much? Alcohol is the most commonly used potentially addictive substance in our society. Alcohol is responsible for over half of the $267 million dollars of substance related hospital costs in Canada. Problematic alcohol use significantly impacts individuals, families, and our community, but many struggle to know if they have a problem and where to go for help. Learn more: http://www.theroyal.ca/mental-health-centre/news-and-events/newsroom/13411/alcohol-how-much-is-too-much/

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