ALCOHOL USE

Background

Although alcohol consumption has fallen since the late 1970's, Australians are still relatively big drinkers and spend over $400 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.

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	one
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
	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 others 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 from 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 Harm

Don't drink alcohol to quench your thirst. Use non-alcoholic drinks. 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. Provide 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 DETOX UNIT – Lot 497 Parklands Dve, Southport. Ph: 07 5571 5248. Provide short term detoxification for people wanting to withdraw from alcohol. Introduction to the 12 step programme of AA.

FAIRHAVEN REHABILITATION UNIT – Lot 497 Parklands Dve, Southport. Ph: 07 5594 7288 longer-term residential programme for people with drug or alcohol problems.

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 service – 2741 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 INC – 8 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 SERVICE – 15 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 hepatitis

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