Evaluation article: Alcohol misuse

Published: Monday, 16 June 2014

Martin Hodgson writes about how to support people involved with alcohol misuse in adult social care.

Summary

  • Alcohol addiction is where an individual becomes dependent on alcohol and continues to drink despite the physical, psychological and social problems that it causes.
  • Long-term heavy drinking can lead to serious physical health problems such as liver disease and heart disease.
  • Denial is one of the biggest obstacles to getting help for people with alcohol problems.
  • Social care staff can help by ensuring that service users who want to address their drinking problems have adequate support and encouragement.

Problem drinking

Most people enjoy a drink of alcohol occasionally and the majority have a problem-free relationship with it, drinking moderately for pleasure. However, others may experience an unhealthy relationship and alcohol may start to have a negative effect on them.

It is not always easy to see when drinking alcohol has crossed from moderate or social use to higher-risk or problem drinking, but those who consume alcohol to cope with difficulties and cannot get through the day without having a drink are showing signs of the relationship changing to something potentially unhealthy.

Higher-risk alcohol problems are often referred to as alcohol abuse or misuse.

Alcohol dependence or addiction is a situation where an individual becomes dependent on alcohol, either physically or mentally, and continues to use it despite the physical, psychological and social problems that it causes. Severely dependent drinkers are considered to be suffering from a serious medical condition where drinking alcohol becomes a physical compulsion.

Tolerance and withdrawal

People who drink heavily build up a tolerance to alcohol which means they have to drink more to achieve the same effect. In such cases stopping drinking alcohol may elicit a reaction in the body which includes tremor – often referred to as ‘the shakes’ – sweating, headache, craving and nausea. Such withdrawal symptoms generally start three to eight hours after the last drink and many people continue to drink in order to keep the symptoms at bay.

Delirium tremens is a potentially life-threatening withdrawal reaction affecting some severely dependent drinkers.

Drinking limits

Doctors recommend people to drink sensibly in order to prevent harm and to lower the risk of alcohol dependence.

Men are advised to drink no more than 21 units of alcohol per week, no more than four units in any one day, and have at least two alcohol-free days a week.

Women are advised to drink no more than 14 units of alcohol per week, no more than three units in any one day, and have at least two alcohol-free days a week.

One unit of alcohol is in about half a pint of beer, two thirds of a small glass of wine or one small pub measure of spirits.

Signs and symptoms

Long-term alcohol use can cause serious health complications, including:

  • gastritis and stomach ulcers
  • heart disease
  • liver and brain damage, such as cirrhosis, jaundice and memory loss.

Higher-risk drinkers are more likely to be overweight, to get cancer of the mouth, neck and throat, and to develop high blood pressure.

Problem drinking can also damage a person’s emotional and psychological stability and their relationships. It can have a critical impact on family and friends and lead to emotional strain and tension as well as mood and behavioural changes.

People who drink heavily and get drunk often are more likely to have accidents. They lose their inhibitions when under the influence of drink and can become aggressive and argumentative.

Why do people develop alcohol dependence?

There is no particular reason why someone develops a dependence on alcohol. Those who have a family history of alcoholism may be more likely to develop alcohol problems, as do those who associate closely with heavy drinkers.

Those who suffer from a mental health problem such as anxiety or depression are also prone to alcohol misuse. People often drink to ‘self-medicate’ and try and reduce the symptoms. However, in the long term alcohol may make these disorders worse.

Drinking problems and denial

Admitting to having a problem is crucial in getting help.

In alcohol abuse the desire to drink is very strong and people often find ways to rationalise their drinking. Denial is one of the biggest obstacles to getting help for alcohol problems and will often lead to a person underestimating how much they drink and downplaying the negative consequences.

Keeping a drinks diary is one way of identifying how much someone really drinks.

Helping service users with alcohol problems

When an alcohol problem is identified it should be approached sensitively and confidentially, especially if the service user denies that they have a problem. Giving the service user the time and opportunity to talk their problems through is an important element of care and can lead to the person deciding to take action and accept treatment.

It can also help to address a service user’s problems, for example many people in adult social care drink in response to loneliness, stress or bereavement and much can then be done to help the individual develop a more appropriate way of coping with their feelings.

Recognising that they have a drinking problem and deciding to do something about it is the crucial first step. The next step is usually for the person to decide whether to merely moderate their drinking or stop drinking completely.

Service users at this stage should be given adequate support and encouragement by staff and helped to access professional help to talk through the options. This will usually be through the service user’s GP or an alcohol counselling service.

Someone who chooses moderation will usually be asked to continue with counselling and should be given plenty of support to help them control
their drinking.

Detoxification

People with severe alcohol dependency will usually be advised to stop drinking altogether and their GP will prescribe a detoxification plan which includes medication to treat the withdrawal symptoms and often a vitamin supplement.

People should not stop alcohol suddenly if they are alcohol-dependent as the withdrawal effects can be severe and may be dangerous. For most people a phased supervised detoxification in the community is usually advised. Detoxification can be unpleasant and the service user may be referred for specialist support if required.

Residential rehabilitation services are also an option for those who require 24-hour medical care while they withdraw.

Those who are higher-risk, or have more complex long-term problems with alcohol, will invariably need help from other healthcare professionals and a care plan that addresses their physical, mental and social care needs.

After a successful detoxification some people go back to drinking heavily again and relapse. On-going support by care staff and help from family, friends, local support groups and alcohol counselling services can help to prevent this.

Further information

Toolkit

Use the following items in the toolkit to put the ideas in the article into practice:

About the author

Martin Hodgson MSc, PGCEA is a community psychiatric nurse by background, and has had a long career working as a senior manager in various health agencies, including mental health, primary and community care.

This article was first published in the October 2013 issue of Quality & Compliance Magazine. 

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