adding alcohol to the equation? drug users who drink
TRANSCRIPT
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Adding Alcohol To the Adding Alcohol To the Equation?Equation?
Drug Users Who DrinkDrug Users Who Drink
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Is there a problem?Is there a problem?
1990 – Almost 100% was Alcohol problems1990 – Almost 100% was Alcohol problems
In 1992 3% of our Clients were under 25In 1992 3% of our Clients were under 25No IVDUNo IVDUPrescribed use MinimalPrescribed use Minimal
2002 an equal split between age groups2002 an equal split between age groupsHigh amounts of Heroin useHigh amounts of Heroin useRapid transition to IVDURapid transition to IVDU
2002 we started to notice a link between drug and alcohol use2002 we started to notice a link between drug and alcohol use
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Arising AwarenessArising Awareness
At first through observation on street At first through observation on street work and needle exchangework and needle exchange
By requests for AlcometerBy requests for Alcometer
Through alliances between at first Through alliances between at first apparently disparate groupingsapparently disparate groupings
Through networkingThrough networking
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LocationsLocations
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Other IssuesOther Issues
Interaction with other drugs – Lothian Interaction with other drugs – Lothian OverdosesOverdoses
Issues around HEP CIssues around HEP C
Aggression and ViolenceAggression and Violence
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But Why?But Why?
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"I'll Die Young, but It's Like"I'll Die Young, but It's LikeKissing God"Kissing God"
The Consumption of Heroin Is Marked by a The Consumption of Heroin Is Marked by a Euphoric Rush, a Warm Feeling of Euphoric Rush, a Warm Feeling of Relaxation, a Sense of Protection, and a Relaxation, a Sense of Protection, and a dissipation of pain, fear, hunger, tension dissipation of pain, fear, hunger, tension and anxiety. and anxiety.
When Heroin Is Snorted or Smoked but When Heroin Is Snorted or Smoked but Especially Injected, the Rush Is Intense Especially Injected, the Rush Is Intense and Orgasmic. Subjectively, Time May and Orgasmic. Subjectively, Time May Slow Down. Anger, Frustration and Slow Down. Anger, Frustration and Aggression Magically Disappear.Aggression Magically Disappear.
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We replace withWe replace with
MethadoneMethadone
DF118sDF118s
Enforced ReductionEnforced Reduction
Abstinence AloneAbstinence Alone
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Remember …Remember …
Heroin Works..Heroin Works..
QuicklyQuickly
ConsistentlyConsistently
Without workWithout work
EfficientlyEfficiently
Works well with traumaWorks well with trauma
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The Effect Of HeroinThe Effect Of Heroin
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And Titrated MethadoneAnd Titrated Methadone
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Client CClient C
I hated drugs – hated drug users but I hated drugs – hated drug users but one night I was rattling of the drink one night I was rattling of the drink someone gave me a burn – I felt someone gave me a burn – I felt normal for the first time in my lifenormal for the first time in my life
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Other Possible Factors In Rise Of Other Possible Factors In Rise Of Alcohol useAlcohol use
Controlled DispensingControlled Dispensing
Diazepam ceilingsDiazepam ceilings
Fake DiazepamFake Diazepam
Mundanity of Methadone LifestyleMundanity of Methadone Lifestyle
Social ExclusionSocial Exclusion
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The Muirhouse ExperienceThe Muirhouse Experience
Reasons for researchReasons for research
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Initiated through NEARInitiated through NEAR
Response to new problemResponse to new problem
Identified as not conventional issuesIdentified as not conventional issues
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Attitude to DrinkingAttitude to Drinking
When asked how they felt about their When asked how they felt about their drinking patterns, 58% of the group drinking patterns, 58% of the group replied that they were unhappy with replied that they were unhappy with the level of alcohol intake. Of that the level of alcohol intake. Of that 58%, half wished to drink less, and 58%, half wished to drink less, and the remaining half wished to stop the remaining half wished to stop drinking altogetherdrinking altogether
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But All very Interesting…But All very Interesting…
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DrugsDrugs
The vast majority of those The vast majority of those interviewed were on maintenance interviewed were on maintenance prescriptionsprescriptions
Practically all had at one time used Practically all had at one time used opiates in one form or anotheropiates in one form or another
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Routes for helpRoutes for help
0
5
10
1520
25
30
35
40
4550
Friends Family GP NEDAC Police Social Work Community Groups Housing Support Worker
Proposed avenues of assistance
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Why Lack of Clarity?Why Lack of Clarity?
Social acceptability of alcoholSocial acceptability of alcohol
Inability to assessInability to assess
Unwillingness to challengeUnwillingness to challenge
Scale of issue compared to HeroinScale of issue compared to Heroin
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For us as drug workers…For us as drug workers…
Alcohol misuse by clients undergoing Alcohol misuse by clients undergoing Methadone Treatment Programmes Methadone Treatment Programmes has been recognised as a factor in ….has been recognised as a factor in ….• Poor treatment outcome Poor treatment outcome • Increased morbidity Increased morbidity • Early termination of treatmentEarly termination of treatment
Methadone/Opiate related deathMethadone/Opiate related death Increased social, family and Increased social, family and
psychiatric disorderpsychiatric disorder
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Client JClient J
I found myself at the offy at 7.30 in the I found myself at the offy at 7.30 in the morning ..I would look at the troops morning ..I would look at the troops at the pharmacy waiting for their at the pharmacy waiting for their script and say” Thank god I’m nae script and say” Thank god I’m nae like them no more” ..”I didn’t know it like them no more” ..”I didn’t know it I was worse”I was worse”
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Size of the ProblemSize of the Problem
Heavy drinking is widespread among Heavy drinking is widespread among drug users. Heavy drinking can be a drug users. Heavy drinking can be a serious threat to the health of drug serious threat to the health of drug users because of the high rates of users because of the high rates of liver disease among drug injectors liver disease among drug injectors and because of the increased and because of the increased potential for drug overdose when potential for drug overdose when alcohol and drugs are used togetheralcohol and drugs are used together
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Alcohol Consumption – NTORSAlcohol Consumption – NTORSNational Treatment Outcome National Treatment Outcome
Research StudyResearch Study 68% reported drinking alcohol in the 3 68% reported drinking alcohol in the 3
months prior to treatmentmonths prior to treatment 32% had not consumed any alcohol during 32% had not consumed any alcohol during
this periodthis period 27% of clients drank above recommended 27% of clients drank above recommended
limitslimits 14% of the clients drank on a daily basis14% of the clients drank on a daily basis 8% were drinking in the region of 45 units 8% were drinking in the region of 45 units
on a daily basis on a daily basis
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Alcohol Consumption - NTORSAlcohol Consumption - NTORS
Heavy drinking can present serious Heavy drinking can present serious problems for a proportion of the problems for a proportion of the treatment population and it has been treatment population and it has been suggested that treatment programs suggested that treatment programs for drug users sometimes overlook or for drug users sometimes overlook or fail to respond effectively to alcohol fail to respond effectively to alcohol problemsproblems
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Assessing Alcohol UseAssessing Alcohol Use
Every client should be asked about their Every client should be asked about their drinking and specific information about drinking and specific information about this should be recorded in their notes/care this should be recorded in their notes/care planplan
Observable signs and symptomsObservable signs and symptoms• IntoxicationIntoxication• Smell (Alcometer)Smell (Alcometer)• Symptoms of withdrawalSymptoms of withdrawal
Tremors, sweatsTremors, sweats
• Physical stigmataPhysical stigmata Puffy/flushed face, Weight changesPuffy/flushed face, Weight changes
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Assess current consumption:-Assess current consumption:-• What What • How much - ABV & QuantityHow much - ABV & Quantity• How oftenHow often• How long forHow long for• Why Why • Where, Who withWhere, Who with• DIARYDIARY
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Abrupt CessationAbrupt Cessation
Alcohol Withdrawal ContinuumAlcohol Withdrawal Continuum
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Practice Issues to considerPractice Issues to consider
Harm MinimisationHarm Minimisation Hepatitis C/BHepatitis C/B Increased risk associated if also Increased risk associated if also
using Benzodiazepinesusing Benzodiazepines Individuals substituting alcohol for Individuals substituting alcohol for
opiates while stabilising on opiates while stabilising on methadonemethadone
Staff TrainingStaff Training Risk assessment - Overdose etcRisk assessment - Overdose etc
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NTORSNTORS
All drug services need to look at All drug services need to look at strategies to keep alcohol on their strategies to keep alcohol on their agendaagenda
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There is no longer a Berlin WallThere is no longer a Berlin Wall