Whelehans Health Blog

Wednesday, 29 January 2014

How to deal with Alcohol Addiction

I will only touch on the treatment of alcohol addiction for the health blog. It is a long and hard process and a person must want to give up alcohol to be successful. Call into Whelehans Pharmacy for more detailed information or check www.whelehans.ie. All information is free and is confidential. Treatment depends on the amount of alcohol a person is drinking. Treatment options include detoxification, medication and counselling. Abstinence is the best and most successful approach to beat alcohol addiction.

In mild cases, detox can be done at home without the use of medication because withdrawal symptoms should be mild. If consumption of alcohol is high (over 20 units a day) or withdrawal symptoms were previously experienced, detox at home with medication to help ease withdrawal symptoms may be possible. A short course of a tranquiliser called chlordiazepoxide (Librium®) is usually prescribed in this case (for about 5 days). If dependency is severe, detox at a hospital or clinic may be required as withdrawal symptoms will be severe.  

Withdrawal symptoms
Withdrawal symptoms are worst for the first 48 hours. They gradually start to improve as the body begins to get used to being without alcohol. This usually takes 3-7 days from the time of the last drink. Sleep will be disturbed. Sleep patterns often start to return to normal within a month. During detox, it is important to drink plenty of fluids (about three litres a day). Avoid drinking large amounts of drinks containing caffeine like tea and coffee as caffeine exacerbates sleep problems and cause feelings of anxiety. Stick with water, squash or fruit juice to re-hydrate. Try to eat regular meals even if not feeling hungry. Normal appetite will return gradually. Withdrawal from alcohol is an important first step; further treatment and support will be needed as it is a long term struggle to stay dry.

The three most common drugs used to treat alcohol addiction are acamprosate, disulfiram and naltrexone.

Acamprosate (brand name Campral®) is used to help prevent a relapse in people who have successfully given up alcohol and works by helping reduce craving. Acamprosate works by blocking a chemical in the brain called gamma-amino-butyric acid (GABA). GABA helps cause a craving for alcohol. Acamprosate is usually started as soon as withdrawal from alcohol begins and can be prescribed for up to six months. I will discuss the other drugs used to treat alcohol addiction and other counseling options next week.

Disulfiram (brand name Antabuse®) is a drug that may be tried if trying to achieve abstinence if relapse is a possibility. Disulfiram works by causing unpleasant physical reactions if alcohol is consumed thus acting as a deterrent. These can include nausea, chest pain, vomiting, flushed skin and dizziness. Unpleasant reactions can occur if the person comes into contact with alcohol for a week after finishing taking disulfiram, so it's important to avoid alcohol for a week after stopping disulfiram.

Naltrexone works by reducing the enjoyment someone gets from alcohol thus reducing drinking or helping someone give it up completely. It works by blocking the opioid receptors in the body, stopping the effects of alcohol. It's usually used in combination with other medicine or counselling. Naltrexone should only be prescribed by a specialist in alcohol dependence.


Self-help groups
Alcoholics Anonymous (AA) is a great support to many fighting alcohol dependence. The core belief behind AA is that alcoholic dependence is a long-term condition and total abstinence is the only solution. AA has a 12-step programme designed to help overcome addiction. It includes the following steps •Admitting a powerlessness over alcohol and that a normal fulfilled life with alcohol is impossible. •Realising that you cannot fight the addiction without support. •Examining past errors with the help of a sponsor (an AA member who has been through it before). •Making amends for errors made. •Living a new more fulfilled life without alcohol and improving behaviour. •Helping others who are going through the same addiction problems

Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) uses a problem-solving approach to alcohol dependence.  CBTs approach to alcohol dependence is to identify and deal with unhelpful and unrealistic thoughts and beliefs that contribute to continual drinking such as: •"I can't relax without alcohol." • “all my friends drink” • “I can’t enjoy a social occasion without alcohol” •"Just drinking one pint can’t hurt."

The idea of CBT is to change these unhelpful thoughts and perceptions to: •"I can have a good time without alcohol" • “I don’t need the hassle of feeling miserable with hangovers” • “I will join new clubs and societies that don’t involve alcohol to make new friends that I can meet without having to drink”  •"I know I can't stop drinking once I start." Other types of therapy include Extended Brief Intervention and Family Therapy

Community Alcohol and Drug Service (CADS)
The HSE Community Alcohol and Drug Service offer counselling and treatment services for adults suffering from addiction to alcohol, drugs and gambling. CADS have centres in Mullingar, Athlone and Longford. CADS provides counselling and treatment to help people get over their addiction and offer support and counselling to family members. All services are totally confidential. You can refer yourself to the service directly. If you have a loved one or someone you know that could avail of this service you can contact CADS to discuss your options. All referrals must be made with the consent of the person being referred. You can contact their Mullingar centre at 04493 41630.

Disclaimer: Please ensure you consult with your healthcare professional before making any changes recommended

This article is shortened for this health blog. More detailed information and leaflets is available in Whelehans or www.whelehans.ie


Saturday, 25 January 2014

Alcohol Health Problems

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

Alcohol is safe if drank in moderation. Alcohol releases endorphins in the brain which is why it makes us feel good (and why it is so addictive); it also affects the area of the brain that causes inhibition which is why it makes us talk more and feel more relaxed.
Tonic or poison?
Alcohol can be described as both a tonic and a poison. The difference between “tonic and poison” lies in the dose. Moderate levels of alcohol can be beneficial for the heart and circulatory system, and may protect against diabetes and gallstones. However excessive alcohol intake can cause many health problems and premature death. While alcohol is an enjoyable social lubricant, we must also remember that alcohol is drug. The drug in alcohol is “ethanol” which affects the brain, heart, stomach, liver and gallbladder. It affects many other common functions including inflammation, coagulation (blood’s ability to clot), cholesterol and insulin levels. It also alters mood, concentration, and coordination. These affects lead to serious health problems if used in excess. As alcohol is a drug, it also interacts dangerously with many medicines, including paracetamol and other painkillers, antidepressants, epilepsy drugs and sedatives. Alcohol is very addictive and your tendency to become addicted is also thought to be hereditary (ie) those with a family history of alcohol problems are more at risk.

How do you know if you’re drinking too much alcohol?
You could be drinking excessively if: You feel you need to cut down on drinking. You feel guilty or ashamed about your drinking. Other people are critical of how much you drink. Sometimes have memory loss of drinking sessions. You need a drink first thing in the morning to settle nerves or ease a hangover. Drink at least a few drinks every day. Regularly go binge drinking. Not doing as expected due to drinking (eg) missing an appointment or work due to being drunk or hungover.

Long-term effects of alcohol abuse
Abuse of alcohol can cause 63 different diseases to our body; I will just discuss the more common ones.

Excess drinking reduces the number of red blood cells which carry alcohol around the body and can cause red blood cells to become extremely low. This is called anaemia and can cause many symptoms like fatigue, lightheadedness and shortness of breath.

Many studies show that continual heavy drinking increases cancer risk. One of the reasons for increased cancer risk is that the body converts alcohol into acetaldehyde, a known carcinogen. Areas where alcohol is known to increase cancer risk include the mouth, throat, larynx (voice box), oesophagus, liver, breast, and colorectal region. Cancer risk rises even further in heavy drinkers who also smoke.

Cardiovascular disease
Heavy drinking, especially binge drinking makes platelets more likely to stick together to cause blood clots increasing risk of heart attack and stroke. Excessive drinking can also cause cardiomyopathy, a potentially fatal condition where the heart muscle weakens and can eventually fail. Excessive alcohol can cause heart rhythm problems such as atrial and ventricular fibrillation both of which lead to the heart not pumping properly and can lead to clots and death.

Alcohol can cause damage to liver cells if overused over a prolonged period of time. Heavy drinkers can develop cirrhosis, a sometimes lethal condition where the liver is so heavily scarred that it cannot function properly.

As a person ages, the brains shrinks at an average of approximately 2% per decade. However heavy drinking accelerates the shrinkage of key areas in the brain leading to memory loss and other symptoms of dementia. Heavy drinking can also lead to mild but potentially debilitating problems including a person’s ability to plan, make judgments, solve problems and perform complex tasks.

Heavy drinking is often associated with depression. It has often been debated which comes first, the drinking or the depression. One theory is that depressed people use alcohol to ease emotional pain. But many studies are showing that is more likely the other way around (ie) it is heavy drinking that leads to depression more than the other way round.
Heavy drinking can cause epilepsy and can trigger seizures even in those that do not have epilepsy. Alcohol can also interfere with the effect of epilepsy medications used to prevent convulsions.

Gout is an inflammatory condition that is more common in men and often affects the big toe. An acute attack of gout is very painful. Gout is caused by uric acid crystals forming in the joints. Although gout is often hereditary, alcohol and other dietary factors often play a role. Alcohol aggravates existing cases of gout.

High blood pressure
Alcohol disrupts the sympathetic nervous system which has a role in controlling the constriction and dilation of blood vessels in response to stress, temperature and exertion. Heavy drinking, especially binge drinking can cause blood pressure to rise. High blood pressure can lead to many other health problems, including heart disease, stroke and kidney problems.

Infectious disease
Heavy drinking suppresses the immune systems which can lead to infections. Studies show that heavy drinking increases the risk of tuberculosis, pneumonia, HIV/AIDS, and other sexually transmitted diseases.

Nerve damage
Heavy drinking can cause a form of nerve damage called alcoholic neuropathy leading to problems such as painful pins-and-needles and numbness in the extremities (eg. fingers, toes) as well problems like muscle weakness, incontinence, constipation and erectile dysfunction. Alcoholic neuropathy arises for two reasons, alcohol is toxic to nerve cells and because nutritional deficiencies (especially vitamin B1 deficiency) thus inhibiting nerve function.

 Oesophagus and stomach
Alcohol has a direct effect on the oesophagus relaxing the lower oesophageal sphincter (valve leading to the stomach) which means “acidic” stomach contents are more likely to come up leading to oseophagitis which can cause symptoms like heartburn in the chest area. Alcohol can also delay gastric emptying which can also lead to heartburn and indigestion.

Effect on nutrition
Excess alcohol consumption reduces the level of many important nutrients. This includes thiamine (vitamin B1) deficiency which can cause nerve damage (described above). Serious vitamin B1 deficiency is common in chronic alcoholics and can lead to a serious condition called Wernicke-korsakoff which is a serious acute condition characterised by confusion, vision changes, lack of coordination and impaired memory. Many people recovering from excessive alcohol consumption require thiamine supplement. Alcohol can also cause vitamin B12 deficiency (leading to symptoms like fatigue) and reduced calcium absorption (leading to brittle bones especially in women).

As well as causing stomach irritation (gastritis), alcohol can inflame the pancreas. Chronic pancreatitis can restrict digestion, causing severe abdominal pain and persistent diarrhoea. Unfortunately this damage is sometimes irreversible. Chronic pancreatitis can be caused by gallstones, but up to 60% of cases are due to excessive alcohol consumption.

I will discuss options to help beat alcohol addiction in the coming weeks in my Health Blog

This article is shortened for this health blog. More detailed information and leaflets is available in Whelehans or www.whelehans.ie