GLASGOW COUNCIL on ALCOHOL Tackling the misuse of alcohol

1. GLASGOW COUNCIL on ALCOHOLTackling the misuse of alcohol • COCAINE AND ALCOHOL • THE HIDDEN MIXER • 9TH OCTOBER 2006 • Alex Meikle

2. GLASGOW COUNCIL on ALCOHOLTackling the misuse of alcohol • PREVALENCE LEVELS IN SCOTLAND: • No of people in Scotland with problematic drug misuse levels in Scotland = 55,000 • No of people in Scotland estimated to be alcohol dependent = 276,213 (Source: Alcohol Concern 2003)

3. GLASGOW COUNCIL on ALCOHOLTackling the misuse of alcohol THE TIERS • Tier 1 Services – General public, prevention, education and awareness • Tier 2 Services - People experiencing moderate to severe alcohol problems e.g. local councils on alcohol • Tier 3 Services - People with severe alcohol problems requiring specialist help e.g. CAT Community Rehab • Tier 4 Services – People with acute alcohol problems requiring residential care or hospitalisation

4. GLASGOW COUNCIL ON ALCOHOL • GCA is composed of five key components, which are: • Prevention and education work • The counselling services including the Alcohol Counselling Centre (ACC), Homelessness, Community Counselling and Young People’s counselling service • Training (both internally and externally) • Groupwork i.e. the ACE Programme • East End Community Alcohol Support Service

5. WHAT GCA DOES . . . . . . . . THE MANTRA!!! ADDS VALUE TO ADDICTION SERVICES WITHIN GREATER GLASGOW BY: • Keep people at Tier 2, prevent them from relapsing to Tiers 3 or 4 and eventually move them to Tier 1 • Assess for, signpost and fast-track for people who need them into Tiers 3 and 4 services • Provide throughcare service for people coming out of Tiers 3 and 4 services

6. GLASGOW COUNCIL ON ALCOHOL • Cocaine use in Scotland is the third highest in Europe (UN report July 2006) • 1.4% of 15-64 year olds use this drug. • Scottish Drugs Misuse Database (2006) reports 8% of all presentations to addiction services in Scotland are using cocaine compared to 5% in 2000/01 • Alcohol use has remained steady at 13% in 2004/05 compared to 12% in 2000/01

7. ALCOHOL AND COCAINE • One study in US estimates that 75% of cocaine users use alcohol both independently and while using cocaine • Harm from using both is greater than using either separately • Treatment outcomes are different for simultaneous use • Therefore, extremely important to identify simultaneous use

8. ALCOHOL AND COCAINE Combined bio-chemical effects: • Alcohol leads to 30% increase in blood levels of cocaine if taken at the same time or just before • Liver combines cocaine and alcohol to produce Cocaethylene which increases dopamine release and can lead to sudden cardiac death

9. ALCOHOL AND COCAINE Combined psychiatric effects: • More euphoric and rewarding leading to an increased high • Decrease in alcohol sedation or cognitive impairment • Increase in interpersonal and physical violence • Increase in sexual risk behaviours • Increase in impulsive decision making and decrease impact on memory and learning

10. ALCOHOL AND COCAINE Consequences: • The bio-chemical effects and the psychiatric effects combine with potentially disastrous consequences • More “Bangs for your bucks” • Less apparent effects of alcohol “I can handle this better” • Two substances which in themselves lead to volatility in individuals have this factor significantly enhanced • More impulsive behaviour • Greater chance of heart failure and sudden death • Treatment is more complicated as there are contra-effects i.e. withdrawl can be accompanied by intoxication

11. ALCOHOL AND COCAINE Conventional Scottish Treatment Characteristics for Service Users • Opiate/Injecting/Alcohol users • Poor • Unemployed • Depressant users • From “Deprived backgrounds” (Dep Cats 6-7) • Strong association with physical and mental health issues as well as issues such as abuse • Addiction as manifestation of deeper issues therefore treatment is necessarily holistic

12. ALCOHOL AND COCAINE Treatment Characteristics for alcohol and cocaine users • Polydrug users with no one substance in ascendancy • Educated/Aspirational/Affluent • Employed • Stimulant user and risk taker with alcohol exacerbating the stimulant • Classless from all backgrounds (Dep Cats 1-7) • No necessary casual connection to other issues • Addiction as hedonism related to lifestyle, culture, availability, leisure clashing with pressures of work and status

13. CONSEQUENCES BUT COMBINATION OF ALCOHOL AND COCAINE CAN LEAD TO: • Spiral into unemployment • Poverty • Abuse • Collapse of self-esteem • Debt • Criminal record • Poor health • Paranoia/anxiety/mental health issues

14. ALCOHOL AND COCAINE Case Study 1 • 37 year old male, employed • Consumes 32-35 units in one session • Started taking cocaine to “last the pace and keep awake” • Cocaine stopped him feeling depressed and worrying about money problems that had arisen over past two years • “Wished the weekend could last forever” • Got arrested: “best thing ever happened to him” • Rude awakening; abstinent from alcohol and cocaine for last five months

15. ALCOHOL AND COCAINE Case Study 2: • 32 year old male, employed, homeowner • Strongly into image, appearance, suntan lounge • Will spend between £300 -£600 per weekend on cocaine and alcohol • After work on Fridays: all day drinking supplemented by cocaine taken in pubs and clubs • Will consume 116 units of alcohol over 1 weekend (up to 52 units in one day) and 2-3 grams of cocaine • “Don’t think you’re drunk, think you’re cool” • End up involved in fighting including broken teeth and black eyes, totally counter to cool image trying to project • On Sundays will drink to “unwind” but end up using cocaine again • Inevitably having problems with work: Tired, depressed and paranoid • Now being given alcohol counselling allied to motivational interviewing, stress management and anger management

16. ALCOHOL AND COCAINE Case Study 3 • 20 year old male from deprived area, unemployed • Drank heavily along with frequent use of cocaine • Motivating factor in taking cocaine along with alcohol was boredom; the combination of the two gave him a greater “buzz” • Made him feel happy and upbeat about his life • Began having seizures, which stopped immediately he ceased using cocaine • Still drinking, but not as heavily • Receiving counselling

17. ALCOHOL AND COCAINE Conclusions: • These two substances in combination are potentially lethal within a relatively short period of time • It is imperative that assessment and screening picks up dependency on both; the conventional assessment of one primary drug and several subsidiary drugs is not appropriate here: this is Co-dependency • The client group will not normally have the typical characteristics associated currently with presentation at addiction services • Use of these two substances would appear to be increasing • They are used normally as part of a lifestyle and not as a response to deep underlying causes • Other problems e.g. criminal record, abuse, unemployment follow on from the use of the substances and not the other way around • Addiction workers have to be empowered and trained to deal with both substances • Addiction services have a major role in secondary prevention work in preventing alcohol and cocaine use from causing the individual to spiral further into chaos and more resources are needed to do this • Location and opening hours of services will have to be considered • More research has to be carried out into the combined effects of both and to treat them as their joint use increases