HARM REDUCTION INFORMATION
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ALCOHOL AND A VISIT TO A&E
A recent report (The report looked at adults seeking emergency care at Bristol Royal Infirmary over a four week period) suggested that one in five patients (20%) said they had drunk alcohol before coming to A&E and 14% felt their injury was related to drink. Of these, around half believed they had been injured by someone who had been drinking, while a similar proportion had consumed more than the maximum recommended weekly units that night. So, what is alcohol and how has it affected you? The information on this page will explain some of the processes which may have resulted in you ending up at A&E, explain what has happened to you during your visit, the treatment you received, and how you can prevent the same thing happening again. WHAT IS ALCOHOL? Alcohol in its many forms has been around for thousands of years and is one of the most widely used drugs in the world. It is very effective at affecting the way you feel and act. The more you drink, the more you feel the changes, and the more impact it has on your body. Alcohol comes in many different forms - beer, vodka, wine, cider, etc., but contained within them all is a chemical called Ethanol, a CNS (central nervous system) depressant that alters the amount of chemicals (neurotransmitters) your brain produces which, in turn, slows everything down. The amount of alcohol in a drink is referred to to as ABV or Alcohol By Volume (percentage). So that you can measure or count the amount of alcohol in a drink the percentage of alcohol is divided into ‘portions’ of alcohol called units. One unit of alcohol is 10 millilitres of alcohol by amount. A standard measure of wine, half a pint of standard beer or larger or a standard size shot of spirits contains one unit of alcohol. WHAT HAPPENS WHEN YOU START DRINKING ALCOHOL? Alcohol enters your bloodstream through your stomach and small intestine and is then circulated around your body. It passes through the liver where the alcohol is processed or ‘broken down’ but - and this is the important part - your liver can only process alcohol at a steady pace. For the average person this is at the rate of about one unit (half a pint of lager or standard glass of wine or spirits) per hour. This means that if you continue to drink, your blood alcohol level will rise and this will have an increasing effect on your brain and, in turn, the way you behave and feel. HOW DID YOU END UP IN A&E? This question can be answered, in part, by the way alcohol influences your behaviour and plays a part in causing you to act and behave in an unpredictable and erratic manner. Alcohol depresses brain function and the speed at which it processes information, making it difficult to think clearly and make rational decisions. (Think about this next time you decide to have a pop at the 20 stone martial-arts-trained doorperson or put yourself in other risky situations). It does this by changing the balance of chemicals in your brain (remember neurotransmitters from earlier?). The two main chemicals affected are called GABA and Glutamate, which at the correct levels, keep your brain functioning properly and you feeling normal. Alcohol alters the levels of these chemicals and starts to affect your Central Nervous System (CNS), which controls your behaviour and coordinates all the information coming in through your senses, such as your sight and hearing. Part of the CNS controls your heart and breathing, which is slowed down (or depressed) under the influence of alcohol. If you continue to drink, this depression increases and becomes more dangerous, even life threatening. Alcohol affects different parts of the brain in different ways. In small amounts it can help you to relax and improve your sociability, but in larger amounts it causes confusion, erratic behaviour, impaired memory, vomiting, unconsciousness, coma and - possibly - death! DIFFERENT PARTS OF THE BRAIN HAVE SPECIFIC JOBS TO DO. ALCOHOL AFFECTS THESE IN DIFFERENT WAYS. Cerebral Cortex This is where thought processing and consciousness are found. Alcohol relaxes this area making you feel less inhibited, but it also slows down the processing of information from the senses (eyes, ears and mouth) and inhibits the thought processes, making it difficult to think clearly and make rational decisions. Cerebellum This controls your movement and balance. Alcohol interferes with this, resulting in the staggering, off-balance walk we associate with being drunk. Hypothalamus and pituitary These areas control automatic brain functions and the release of hormones. Alcohol closes down nerve centres in the hypothalamus that control sexual arousal and performance. Although the desire to have sex may increase, for men the ability to maintain an erection will decrease. Medulla This area of the brain looks after your breathing, consciousness and body temperature. By relaxing the medulla, alcohol induces sleepiness, lowers body temperature, and can slow down your breathing to a point where it stops. ALCOHOL & OVERDOSE >Alcohol poisoning (overdose) is dangerous and can kill. More than 35,000 people were admitted to hospital with alcohol poisoning in England in 2010/11 (16,200 men and 19,800 women) – that’s more than 600 every week. 173 people died from accidental alcohol poisoning in England in 2010. Being able to spot the signs of alcohol poisoning, and what you should and shouldn’t do, could save a life. Signs of overdose Confusion Loss of coordination Vomiting Seizures Irregular or slow breathing (less than eight breaths a minute) Blue-tinged or pale skin Low body temperature (hypothermia) Stupor – when someone is conscious but unresponsive Unconsciousness – passing out There are lots of dangerous myths about how to deal with people who are dangerously drunk. Sometimes it is just as important to know what NOT to do. DON’T: Leave someone alone to just sleep it off. The level of alcohol in someone’s blood can still rise to dangerous levels after they have stopped drinking. Give them coffee. Alcohol dehydrates - giving them coffee will dehydrate them even more and can cause brain damage. Make them vomit. Their gag reflex won’t be working properly and they could easily choke on their vomit. Pick them up and walk them around. Alcohol suppresses brain function; they could easily slip over and injure themselves. Give them a cold shower. Alcohol lowers body temperature. A cold shower will make them colder and possibly cause hypothermia. Give them more alcohol. Their alcohol levels are already dangerously high. Any more alcohol could tip them over the edge. DO: Try to keep them awake and sitting up. If they are able to drink, give them some water. If they pass out, lie them on their side in the recovery position, and check they’re breathing properly. Keep them warm. Stay with them and monitor their symptoms. Don’t mix alcohol & drugs Mixing alcohol with some drugs will exaggerate the effects of both. some will interact and produce other toxic substances and alcohol will stop some medicines from working. Alcohol and drugs are both processed through your liver. As it struggles to cope with both substances it can lead to elevated and dangerous levels of both substances. If you are mixing alcohol with illegal drugs, how do you know what is in the drug you are taking? What is the white powder, or the pill you have taken? Was it the same as last time or something completely different? All very unpredictable and dangerous! Let’s run through some of the most common substances Stimulants Cocaine/Speed/Ecstasy/Mephedrone Alcohol is a depressant, which means it slows down your breathing and heart rate. Cocaine, speed and ecstasy are stimulants. The depressant alcohol tries to slow down your system, whilst the stimulants try to speed it up, putting your brain and heart under a lot of pressure. In addition, combining alcohol and cocaine produces a third toxic chemical called cocaethylene, which puts additional strain on you body and can cause heart-attacks and strokes. If you have an underlying heart condition there is an increased risk. Most deaths from stimulant drugs are related to overheating and dehydration. Combined with the dehydrating effects of alcohol, the risk is increased. Depressants GHB & GBL/Heroin & methadone/tranquilisers Combining one depressant with another is doubling the risk of respiratory failure - you stop breathing!. GHB & GBL has a sedative effect, dulling your inhibitions and making you sleepy. By itself, it can cause unconsciousness, coma or death, so mixing it with alcohol is particularly dangerous. Heroin, methadone and tranquilisers (valium, librium, etc. are powerful sedatives and if you mix them with alcohol then you have a much higher risk of overdosing. Even a moderate amount of alcohol can lower the level of heroin that leads to a fatal overdose. Around three-quarters of people who die from heroin overdoses have also drunk alcohol. Prescription medicines You should always check the instructions on the pack and consult your doctor about the risks of using alcohol with prescribed medication. Antidepressants Drinking alcohol can make your depression worse, slow you down and make you feel drowsy, which is dangerous in situations where you need to be alert, such as driving, or at work. Antidepressants work by increasing the activity of neurotransmitters in the brain (the same chemicals that are affected by alcohol) and can increase the effects of both alcohol and the medication. Alcohol can also make the side effects of your medication much worse . Monoamine oxidase inhibitor (MAOI) type antidepressants, such as phenelzine and isocarboxazid, can be very dangerous mixed with alcohol, and can cause a dangerous rise in blood pressure, causing a stroke. Tranquilisers Any tranquiliser, e.g., Valium (Diazepam), Librium, Temazepam, Nitrazepam, Lorazepam, etc., and alcohol do not mix. Both tranquilisers and alcohol are depressant drugs, so the effects are the same - slowed heart rate and breathing, low blood pressure and drowsiness. The combined effects of both can often result in overdose and can be fatal. Signs of an overdose The signs of overdose can vary, depending on the types, combinations and amounts of drugs consumed and if alcohol is involved. Someone who has overdosed may show one or more of the following symptoms. Irregular or slow breathing (less than eight breaths a minute, or 10 seconds between each breath) Unconsciousness (can’t be woken up even if their name is called or they are shaken vigorously) Faint and irregular pulse Blue-tinged or pale skin Loss of coordination Vomiting Seizures Muscle spasm Extremes of body temperature (either very hot, but not sweating, or very cold) CALL AN AMBULANCE! If they are not responding or getting any better, don’t delay, dial 999 for an ambulance immediately! If they are unconscious place them in the recovery position (see below) so that if they vomit it will drain away and not choke them. Stay with them until the ambulance arrives, and tell the medics how much alcohol they have had, and what else they have taken. Don’t worry, you won’t get into trouble and this could save their life. If the person is conscious and panicking or hyperactive, reassure them that they will be alright if they relax and calm down. Explain what’s happening to them and what you are going to do. A&E TREATMENT The treatment you receive during your stay at A&E varies depending on how serious your condition is and if you have just used alcohol, or alcohol in combination with other substances. When you come into A&E we assess your condition before we make decisions regarding your treatment. This is known as ‘triage’ and help us decide if you need treating immediately or can wait. The length of your wait will depend on your condition and how busy the A&E is at the time. The kind of treatment an individual receives is decided on a case-by-case basis. In general, if your blood alcohol concentration (BAC) is at a dangerous level, we would normally attach you to a saline drip to counteract the dehydrating effects of the alcohol and to get fluids back into your system and we would also attach a monitor to check the oxygen levels in your bloodstream, in case the alcohol has slowed your breathing and heartbeat to a rate that could be life threatening. Mainly, it is just a question of time. As mentioned earlier, your liver can only breakdown alcohol at a steady rate. Once any necessary medical interventions have been carried out, we put you in the recovery position and let you sleep it off before sending you home. YOUR NEXT DRINK What’s going to happen when you have your next drink? Your visit to hospital has cost approximately £700.00 and has taken up the time and resources of ambulance staff, A&E doctors, nurses and other hospital staff. But, did it really need to happen? It’s obvious but the only way to stop this happening (apart from never drinking again) is to reduce the amount and change the way you drink. The following suggestions can help you take control of your drinking and avoid another trip to A&E. Start drinking later Delay the time you start drinking. Go to the pub an hour later than normal or, if you are having a drink at home, occupy yourself by reading a book, playing with the kids for a bit longer, or replacing your alcoholic drink with soft or low alcohol ones. The same for less Check the label on the bottle or have a look for the alcohol by volume (ABV) number on the pump. The higher the number the more alcohol the drink contains. Some continental and designer-type drinks can have high percentages of alcohol. Try to stick to standard or lower-alcohol drinks. Size does matter In the battle for your custom, pubs and clubs are trying to tempt you with more and more offer and measures are getting larger, so be careful when ordering your drink - always check what the standard measure is The difference between a small glass of wine, 125mls (1 unit), and a large glass of wine, 250ml (3 units) is considerable. One minute I was OK - then the next...! Knocking back shot after shot, getting involved in drinking games, or trying to down a pint as fast as you can, means your liver will struggle to cope with the amount of alcohol you are sending it. Your alcohol level will rapidly build up, delivering a massive dose of alcohol to your brain, knocking you for six - one minute you were OK, and then the next... Don't forget the ‘eat’ part of ‘eat drink and be merry’ Eat something before you drink. The food in your stomach will help absorb the alcohol and release it at a steadier rate. Drinking on an empty stomach can mean you take the knock, as alcohol levels build up quickly and your system struggles to cope. Large amounts of alcohol on an empty stomach can also irritate the stomach lining, causing you to vomit. Miss a round You don’t have to have an alcoholic drink every time someone goes to the bar. Try a shandy or a soft drink. Or, as an alternative to rounds, why not have a kitty instead. Agree on the number of drinks and the amount you are going to spend - and stick to it! YOUR ALCOHOL USE Was this a one-off, or has alcohol caused you problems before? People react in different ways to alcohol. For some people alcohol can help them relax and enjoy social occasions; for others, it will damage their health and personal life. Consider the questions below about your alcohol use. Could you be developing an unhealthy relationship with alcohol? Do you find it difficult to stop drinking once you’ve started? Have you neglected work, college or school because of alcohol? Do people close to you worry about the amount you drink? Do you take risks when you’ve had a drink, such as driving a car or getting into fights? Do you drink more than five days a week and regularly drink more than nine units at each session? Do you regularly think about when you can have your next drink? Have you found it difficult to enjoy yourself or relax without alcohol? Have you ever been involved in violence when you have been drinking? If any of the above apply to you then you should consider cutting down. If you can answer ‘yes’ to a couple of these points, it might be worth your while getting a bit more help and advice. Contact any of the organisations on the back page of this booklet, or have a look at the ‘help in your area’ in this pack. It lists services and organisations in your area that can help you. Further Help and Support We hope you have found this alcohol information useful. If you feel you need extra support, consider talking to someone. Maybe a close friend, partner or a local support service. Below are some organisations that can also help you: Drinkware Drinkaware aims to increase awareness and understanding of the role of alcohol in society, enabling individuals to make informed choices about their drinking. www.drinkaware.co.uk Live well - NHS alcohol support Alcohol advice, tips and tools to help you make the best choices about your health and wellbeing nhs.uk/live-well/alcohol-support/ Talk to frank National drugs awareness site for young people and parents/carers. 24 hrs a day, seven days a week. Call 0800 77 66 00 (calls are free and confidential) www.talktofrank.com
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