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Adding Alcohol To the Equation?

Adding Alcohol To the Equation?. Drug Users Who Drink. Is there a problem?. 1990 – Almost 100% was Alcohol problems. In 1992 3% of our Clients were under 25 No IVDU Prescribed use Minimal 2002 an equal split between age groups High amounts of Heroin use Rapid transition to IVDU

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Adding Alcohol To the Equation?

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  1. Adding Alcohol To the Equation? Drug Users Who Drink

  2. Is there a problem? 1990 – Almost 100% was Alcohol problems In 1992 3% of our Clients were under 25 No IVDU Prescribed use Minimal 2002 an equal split between age groups High amounts of Heroin use Rapid transition to IVDU 2002 we started to notice a link between drug and alcohol use

  3. Arising Awareness At first through observation on street work and needle exchange By requests for Alcometer Through alliances between at first apparently disparate groupings Through networking

  4. Locations

  5. Other Issues Interaction with other drugs – Lothian Overdoses Issues around HEP C Aggression and Violence

  6. But Why?

  7. "I'll Die Young, but It's LikeKissing God" The Consumption of Heroin Is Marked by a Euphoric Rush, a Warm Feeling of Relaxation, a Sense of Protection, and a dissipation of pain, fear, hunger, tension and anxiety. When Heroin Is Snorted or Smoked but Especially Injected, the Rush Is Intense and Orgasmic. Subjectively, Time May Slow Down. Anger, Frustration and Aggression Magically Disappear.

  8. We replace with Methadone DF118s Enforced Reduction Abstinence Alone

  9. Remember … Heroin Works.. Quickly Consistently Without work Efficiently Works well with trauma

  10. The Effect Of Heroin

  11. And Titrated Methadone

  12. Client C I hated drugs – hated drug users but one night I was rattling of the drink someone gave me a burn – I felt normal for the first time in my life

  13. Other Possible Factors In Rise Of Alcohol use Controlled Dispensing Diazepam ceilings Fake Diazepam Mundanity of Methadone Lifestyle Social Exclusion

  14. The Muirhouse Experience Reasons for research

  15. Initiated through NEAR Response to new problem Identified as not conventional issues

  16. Attitude to Drinking When asked how they felt about their drinking patterns, 58% of the group replied that they were unhappy with the level of alcohol intake. Of that 58%, half wished to drink less, and the remaining half wished to stop drinking altogether

  17. But All very Interesting…

  18. Drugs The vast majority of those interviewed were on maintenance prescriptions Practically all had at one time used opiates in one form or another

  19. Routes for help

  20. Why Lack of Clarity? Social acceptability of alcohol Inability to assess Unwillingness to challenge Scale of issue compared to Heroin

  21. For us as drug workers… Alcohol misuse by clients undergoing Methadone Treatment Programmes has been recognised as a factor in …. • Poor treatment outcome • Increased morbidity • Early termination of treatment • Methadone/Opiate related death • Increased social, family and psychiatric disorder

  22. Client J I found myself at the offy at 7.30 in the morning ..I would look at the troops at the pharmacy waiting for their script and say” Thank god I’m nae like them no more” ..”I didn’t know it I was worse”

  23. Size of the Problem Heavy drinking is widespread among drug users. Heavy drinking can be a serious threat to the health of drug users because of the high rates of liver disease among drug injectors and because of the increased potential for drug overdose when alcohol and drugs are used together

  24. Alcohol Consumption – NTORSNational Treatment Outcome Research Study • 68% reported drinking alcohol in the 3 months prior to treatment • 32% had not consumed any alcohol during this period • 27% of clients drank above recommended limits • 14% of the clients drank on a daily basis • 8% were drinking in the region of 45 units on a daily basis

  25. Alcohol Consumption - NTORS Heavy drinking can present serious problems for a proportion of the treatment population and it has been suggested that treatment programs for drug users sometimes overlook or fail to respond effectively to alcohol problems

  26. Assessing Alcohol Use • Every client should be asked about their drinking and specific information about this should be recorded in their notes/care plan • Observable signs and symptoms • Intoxication • Smell (Alcometer) • Symptoms of withdrawal • Tremors, sweats • Physical stigmata • Puffy/flushed face, Weight changes

  27. Assess current consumption:- • What • How much - ABV & Quantity • How often • How long for • Why • Where, Who with • DIARY

  28. Abrupt Cessation Alcohol Withdrawal Continuum

  29. Practice Issues to consider • Harm Minimisation • Hepatitis C/B • Increased risk associated if also using Benzodiazepines • Individuals substituting alcohol for opiates while stabilising on methadone • Staff Training • Risk assessment - Overdose etc

  30. NTORS All drug services need to look at strategies to keep alcohol on their agenda

  31. There is no longer a Berlin Wall

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