Government and Alcohol Abuse and Treatment
In the last five years, the UK government has reduced spending on substance abuse support services, as the number of people battling addictions to alcohol and addictive substances continues to soar. Since 2013, councils have had to slash their budgets, a move that leaves vulnerable addicts helpless and left in the throes of a vicious addiction cycle.
The number of motorists being administered breath tests has also fallen by 37% following cuts to police numbers (when the Tory government dropped over 20,000 officers). The result is an increase in the number of deterrents on the road and volume of positive breath results.
The budget cuts come at a period when substance abuse related deaths in England and Wales are at a record high. Hospitals are admitting over one million new alcohol-related cases every year and figures from Public Health England show that alcohol is the top risk factor for early mortality, ill-health and disability amongst individuals aged 15-49 years old.
Prevention measures aim to reduce alcoholism and its associated risks. Measures include community and educational interventions that influence alcohol abuse on one hand, and policies regulating alcohol abuse and behaviour on the other. Policies include alcohol taxes, BAC laws, zero tolerance laws and warning labels. Community interventions include the Alcohol Misuse Prevention Study, Project Northland, Life Skills Training, Drug Abuse Resistance Education and Project Star.
In the US, regulations controlling the abuse of alcohol and narcotics have been in place since the 1800s. There have been calls for increased taxation of alcohol, provision of brief interventions and stringent regulation of alcohol advertising to reduce the incidence of sexual violence and drunken behaviour (such as drink-driving, unsafe sex, STD transmission and unplanned pregnancy).
The problem is especially pronounced amongst young people under the age of 21. In many countries, the legal age for consuming alcohol is 21, yet there’s a serious issue of underage drinking. It’s an activity conducted mainly behind closed doors, where most get drunk or tipsy at home before they go out to group hangouts or parties. Some critics argue that minors should be introduced to alcohol earlier, in a controlled environment, where guidance and supervision will be provided, instead of experimentation that leads to life-threatening situations.
If you or anyone you know is struggling with alcoholism, help is available. With the best alcohol rehab facilities in the UK, you’ll detox in a safe environment and receive treatment that aids long-term recovery from substance abuse.
What is alcohol abuse?
Alcohol abuse occurs when an individual has a serious drinking problem, but isn’t physically dependent on alcohol. It is not to be mistaken with alcohol addiction, as they are not the same. Alcohol is an addictive substance, but not everyone who consumes it develops addiction. Abusers are heavy drinkers who drink in spite of the results, but that doesn’t mean they drink on a regular basis. For example, if you’re an alcohol abuser, you might drink once a month, but when you do drink, you put yourself in risky situations, such as brawling in bars, becoming aggressive or driving under the influence.
Alcohol abuse is a pattern of drinking too much liquor in one sitting and you might be suffering from this problem if you can’t stop drinking or it harms your relationship. One alcoholic unit in the UK is 10ml or 8g of pure alcohol. This equals a 76ml standard glass of wine, 25ml standard whisky and 250ml standard beer. In the US, that’s a 12-ounce bottle of beer, 15 ounces of whisky and a five ounce glass of beer.
Symptoms of alcohol abuse include restlessness, violent behaviour, depression, loss of interest in school or work, inability to control drinking and obsession with drinking.
Binge drinking is also a problem which leads people to consume too much alcohol, engage in risky behaviour, damage vital organs in their body and increase the risk of becoming psychologically and physically dependent on alcohol.
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Impact of alcohol abuse on the abuser, family and society
Alcohol has a serious effect on the drinker, their immediate family and society as a whole. The impact results from an increased mental and physical risk associated with alcoholism, as well as social harm caused by alcohol.
An individual with alcoholism may struggle to hold down a job or perform well at school or in life generally. Alcohol is a consuming habit that takes over your life until it becomes all you know and live for. There’s also the risk of neurological problems such as stroke, dementia or neuropathy and physical health problems like liver disease, risk of cancer and gastrointestinal problems.
Alcohol consumption impairs your ability to parent well or be a good partner to your spouse. Children who are most vulnerable suffer Foetal Alcohol Spectrum Disorders when their mothers drink during pregnancy. Research also shows that children whose parents or guardians are alcoholics have deep-rooted emotional and psychological issues, emanating from addicted parents and are three to four times more likely than others to become addicted to similar substances themselves.
Spouses sometimes cover up their partner’s habits or become co-dependent on alcohol, as it strains relations in the marriage. They make excuses for their partner’s alcohol behaviour, lie or clean up all evidence left from alcohol consumption. This enables the partner to drink more, remain in denial and risk falling deeper into alcohol addiction.
When is it time for treatment?
According to doctors in the UK, 63,000 people will die over a five-year period if the problem with cheap liquor is not addressed. Critics have called on England to follow Scotland’s example and raise the minimum price of alcohol to reduce the attraction for drinking and curb alcohol-related problems in the UK.
Most of the problems caused by alcohol can be mitigated through addiction treatment at a UK rehab centre. You know it’s time to get treatment for alcohol use disorder when you lose your job (due to alcohol related problems), are involved in a car accident which results in arrest, suffer a relationship breakdown or find that alcohol is affecting your physical health and life in general.
If you’re exhibiting any physical or psychological symptoms of addiction, it’s time to get help before you’re too far gone. A few signs to look out for include loss of appetite, blackouts after drinking, skin sores, loss of libido, loss of control when drinking, hiding drinking habits, guilt or shame over your drinking and the craving to drink when you wake up in the morning.
You can find help at alcohol rehabilitation treatment centres, where you’ll undergo alcohol detox and learn strategies and tools for sustainable recovery from alcoholism.
Government and alcohol: abuse and treatment
The Department of Health is saddled with the responsibility of creating health policies for the government relating to alcohol misuse. They aim to reduce and prevent harm caused by individuals. This can be categorised by loss of productivity, harm to an individual’s health, social harm caused by problems within the family unit, domestic violence, anti-social behaviour, crime, drink-driving and the resulting effect on victims.
The problem with alcohol abuse has led to an increased annual cost to the NHS of between £17.7 and £25.1 billion a year. Several initiatives have been introduced to promote safe drinking and reduce hospital admissions related to alcohol abuse, including the ‘Know Your Limits’ campaigns.
Addiction experts say local alcohol and drug teams don’t have the required resources to help alcoholics, because of limited local authority funding. The decision has forced people who need addiction treatment to seek help at private rehabs, which are unaffordable for most people. Specialists expect the number of self-referrals to reach their highest levels in 2018.
Alcohol rehabs help people who are struggling with alcohol abuse detox and tackle psychological problems that led to substance use disorder. The problem? Rehab is expensive and many can only afford treatment with help from the NHS. With new cost-cutting measures in place, what will happen to vulnerable people in dire need of treatment for alcohol abuse?
Local government authorities in England and Wales have warned that their efforts to provide support and treatment for alcoholics and substance abusers were undermined by government cuts. The cuts have also increased demand for treatment on an NHS that’s already overstretched.
The history of government policies/laws and actions on alcohol abuse and treatment
UK laws and policies regarding alcohol
The Gin Act was passed in 1736 to control the production of gin, which was an unregulated epidemic at the time. Subsequent riots led to the abolition of the law in 1742.
In 1881, the Sunday Closing Act required public houses to stay closed on Sunday and restricted their operating hours on other days.
The Licensing Act came into effect in 2005 to regulate the activities of establishments where alcohol is sold and served.
Throughout the United Kingdom, pubs, bars, hotels and other premises selling alcohol must be licensed by the local authority. Legislation doesn’t allow alcohol to be sold to young people under the age of 18.
There are generally two types of license: On-license, that requires alcohol be consumed at the premises where it was bought and Off-license, granted to shops, supermarkets and convenience stores.
Guidance for commissioners and providers of alcohol and drug services
Guidance documents, resources and information are meant to help healthcare professionals provide and enhance treatment services and prevent alcohol and drug misuse. These documents draw from available best practice and statistical evidence to describe services a modern alcohol and drug treatment centre should offer in terms of outcomes, effectiveness and value for money. The guidance is useful for Clinical Commissioning Groups, public health leaders, local authority commissioners and independent organisations.
A good drug and alcohol service should provide the following:
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- Intake assessment of patients’ needs, including using recognised tools for risk assessment
- Bloodborne virus screening that accounts for the physical needs of the patient
- Ensuring assessment of needs identifies outcomes and recovery goals – not just needs from substance abuse
- Recognising the psychological and psychiatric needs of the patient
- Recognising social factors such as employment, homelessness and family networks
- Timely and appropriate access to prescriptions
- Peer support, where people provide emotional, practical or social support for each other
- Directory of local services to both professionals and the public
Key messages for commissioners include:
- Treatment that is part of a coordinated public health approach and cheaper for society and health services.
- Commissioning should be based on evidence for effective intervention techniques for substance misuse.
- Treatment should apply to a wide range of complexity of needs for those struggling with alcohol and substance use disorder.
- A role of a commissioner is to ensure local services have both clinical and managerial leadership. Services should be in line with service standards.
- Commissioning for drug and alcohol services should be based on updated local needs.
- Treatment should go beyond patients and address needs of carers, families and extended social network of the patient.
UK guidelines on clinical management
The Orange Book (as it is often known) is a guide for clinicians treating people with alcohol abuse and drug-related problems. The most recent version released in 2017 enumerates guidelines on the latest club drugs and psychoactive substances, prison-based treatment, misuse of over the counter medication and preventing drug deaths.
Core skills for those managing assessment and treatment for alcohol use disorder and substance dependence include:
- Identify and manage alcohol dependence and manage risks
- Identify and manage mental health, co-existing physical health and social problems
- Provide holistic treatment and recovery planning
- Fundamental elements that improve the outcome of psychosocial intervention include:
- Effective therapeutic collaboration between workers providing care and service users
- Develop standard structure for providing care
- Understand the social network from which the patient is trying to recover
- Integrate psychosocial intervention with medication
- Responsibility of medical personnel prescribing medication for pharmacological intervention
- Decision to prescribe is based on clinal guidelines, overall treatment plan, clinician’s experience, discussion with members of treatment team and advice from addiction specialist
Clinicians should have the following goals when prescribing medication:
- Help patient get better
- Reduce/prevent withdrawal symptoms
- Help patient break from unhealthy, risky behaviours associated with alcohol use and stabilise the patient
- Reduce alcohol use and change risky behaviour for positive attitude
Alcohol and drug treatment in prisons and secure settings
In the UK, secure settings include immigration removal centres, prisons, young offender institutions for people aged 18-21 and those under 18, secure children’s homes, training centres and welfare-only homes.
The criminal justice system is covered under the orange document with a key point that treatment for prisoners battling drug and alcohol addiction should be safe, excellent and effective. At the time of prison entry, there will be an assessment and prescription of psychosocial interventions for continued treatment whilst imprisoned.
Withdrawal will be managed with opioid or alcohol withdrawal medication to reduce distress and symptoms. Any co-occurring disorders and mental health issues are assessed and treated. The entire detox process is explained to the patient, alongside the risks and benefits, so that they fully understand the risk of relapse to alcohol after release from prison.
According to recent statistics, over 59,000 adults were treated for alcohol and drug problems in secure settings during 2016-2017. The core of the treatment was psychosocial and the rest involved pharmacological intervention, where medical treatment was applied.
There’s also a need to improve the continuity of treatment to ensure that when prisoners are released, there’s a seamless assimilation to community-based treatment.
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Medications used during alcohol detox
There are no magic pills that automatically cure alcohol dependence. Medication is not treatment in itself, but should be combined with psychotherapy and rehab for effective recovery from alcohol addiction. According to addiction specialist Joseph Volpicelli, the issue is that medication isn’t being prescribed more often because people believe alcoholism is a problem that can be overcome with sheer willpower.
The medications are not substitutes for liquor, but work best when integrated with psychosocial techniques. Medication relieves the craving for alcohol and weakens people’s response to alcohol, making it less reinforcing. Currently, there are three medications used for the treatment of alcohol use disorder. They include:
This medication has been in use for over 50 years. Disulfiram interferes with the degradation of alcohol by inhibiting the aldehyde dehydrogenase enzyme that breaks down alcohol in the body. With no enzyme to break down alcohol, acetaldehyde builds up in the body when you consume a small amount, resulting in uncomfortable side effects such as sweating, nausea, facial flushing, hypotension, tachycardia, shortness of breath and hyperventilation.
Disulfiram-ethanol reaction (DER) occurs to eliminate addictive behaviour through behavioural counter-conditioning and negative reinforcement. A daily dose of 250-500mg is given to the patient. Severe side effects of drinking alcohol after taking disulfiram include congestive heart failure, respiratory depression, myocardial infarction and death.
Scientific evidence shows that the medicine has not been very useful in treating alcoholism. Data from the Agency for Healthcare Research and Quality shows that studies where disulfiram was used produced methodological weakness. It reduced drinking frequency without improving relapse rate.
Naltrexone is effective in reducing the cravings that compel alcoholics to drink and the pleasure derived from consuming alcohol. It is one of the best anti-craving medications for long-term treatment and works by occupying opioid receptors to block the rewarding aspects of drinking. With naltrexone in your brain, alcohol doesn’t generate dopamine, nor produce the intoxication usually associated with alcohol.
It gets to the core of addiction by breaking the positive feedback loop. Instead of drinking five or six bottles, you’ll have one or two without feeling the need to continue drinking. A study on the effectiveness of naltrexone showed one relapse was prevented in every five patients treated (with naltrexone). It effectively reduced short-term relapse when combined with psychotherapy. The recommended dose is 50mg per day in a single dose. Side effects may include headache and nausea.
Acamprosate is a relapse prevention medication for alcohol dependence. It works by restoring the brain’s natural neurotransmitter balance.
Studies have shown that this medication reduces long and short-term relapse rates in patients with alcohol use disorder, when combined with psychotherapy. It is taken orally three times daily and reduces symptoms that alcohol abusers experience when they abstain from liquor for long periods. These symptoms include anxiety, insomnia, rapid mood changes and restlessness that leads to relapse.
Available government help services
With the growing number of people battling alcoholism, governments around the world are using outreach programmes, medication and affordable treatment services to minimise the effects of alcoholism and provide help for vulnerable people who need addiction treatment.
In the UK, there are alcoholic helplines that are free to call, providing confidential support and advice. There are also treatment agencies and support services that help families, communities and individuals manage the effects of alcohol abuse.
Advice for FRIENDS AND FAMILY MEMBERS
- Conduct your own research on alcohol use disorder. You can’t help someone if you’re not well informed about the problem.
- Host an intervention, but practice what you’re going to say beforehand. Timing and location are everything if you want the intervention to be successful. Choose somewhere private.
- Listen without judging.
- Let them know that you’ll be there every step of the way.
- Don’t encourage or enable their drug habit.
- Don’t tell them how to feel or force them to get treatment.
- Don’t blame yourself entirely for their actions.
Options for seeking professional help include:
Alcohol Detox: An inpatient medical detox facility where care professionals help you detox safely and provide medication to ease withdrawal symptoms.
Outpatient and inpatient alcohol rehabilitation: Rehab programmes can run anywhere from for 30 days up to a year. Inpatient alcohol rehab programmes are more structured. They use a combination of medication-assisted treatment and psychosocial therapy techniques such as talk therapy, individual counselling and group counselling to teach skills that help you maintain long-term sobriety.
Mutual support groups
Mutual support groups are an integral part of your recovery journey. They are non-professional groups made up of recovering alcoholics who will offer support to each other. The groups help you take responsibility for your actions whilst under the influence and provide emotional, social and informational support that aids wellness, good health and long-term recovery. Options for recovering alcoholics include:
- Alcoholics Anonymous
- Al-Anon Family Groups
- Alateen for teens
- 12-step groups
- Women for sobriety
- SMART Recovery
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Facts and statistics on alcohol abuse: The UK and worldwide
- 25% of alcoholics experience major depressive illness during their lifetime
- 30% of high functioning alcoholics have a generational or genetic history of alcoholism
- In 2015, 75% of individuals aged 12 and above were currently binge drinkers
- 17 million adults have a problem with alcohol
- About 6% of global deaths are related to drinking alcohol
- The United Kingdom had 8,758 alcohol-related deaths in 2015, with mortality rates highest amongst individuals aged 55-64
- The fifth biggest risk factor for death in the UK is alcohol misuse, especially amongst people aged 15-49
- The NHS spends around £3.5 billion every year on alcohol related illnesses and injuries
- Russia has the highest rate of alcoholism, with 18.2% of the population suffering from alcohol use disorder
- 3 million deaths around the world are related to alcohol abuse
- In 2015, individuals in the US consumed 24 gallons of alcohol on average, most of which
Get help to overcome alcohol abuse
Physical and psychological signs of alcohol abuse are not the only indicators that you need addiction treatment. There are also psychosocial behaviours or past events that necessitate intervention. These include legal problems, engaging in dangerous behaviour under the influence of alcohol, effects of alcohol on your relationships and spending less time on activities you love in favour of consuming alcohol.
Please seek help for your alcohol abuse or addiction now and receive advice that will help you find an alcohol rehab centre that matches your needs. Inpatient alcohol rehab treatment is usually recommended as an exhaustive process that reduces the risk of relapse and prepares you for sober living post-rehab. These rehab facilities include medical detox programmes to ensure you safely detox and withdraw from alcohol in a secure location, supervised by medical professionals.
What Is a high-functioning alcoholic?
Alcoholics who function well without alcohol abuse having any visible effects on their daily life are referred to as high functioning alcoholics. They can have a well-paid job, maintain a wonderful, loving relationship with their partner, kids and friends, but are still an alcoholic. Most functioning alcoholics are in denial about the problem, because they still perform in their jobs. Subsequently, this causes everyone else to overlook any signs of their problem drinking.
When is a person’s drinking considered alcoholism?
No one who drinks heavily can keep it up for long, without problem drinking becoming a real issue that affects their life. Functional alcoholism ranges from mild to severe. If you’re drinking more than three/four bottles of beer, every day for a week as a woman/man, you’re heading towards alcoholism. If you start experiencing legal problems, neglect your responsibilities, deny having a habit or make excuses for your drinking, these are signs of an individual with alcohol use disorder.
How do I know if I’m an alcoholic?
Do you drink before driving? Do you notice that after drinking, you have blackouts or harm yourself or others whilst drunk? Has your drinking led to legal problems or a drop in performance at work or are you unable to stop drinking even with serious health issues? These are a few things to ask yourself if you suspect you might be an alcoholic. Notably, alcoholics have no control over their liquor intake – they drink to feel intoxicated and consequently experience withdrawal symptoms when they try to quit.
Why do people drink too much?
Location, the company you keep and boredom are some of the biggest triggers for excessive drinking. If you’re consuming more than the recommended intake of alcohol (which is 14 units a week), it’s time to reassess your excuses for drinking and cut back, before you develop alcohol dependence. A few reasons people drink include: they’ve had a difficult day and use alcohol as a depressant to help them relax, it’s the weekend and they’re out with friends and feeling pressured to drink as much as their peers, they’re in the mood to party and have a good time or they just got paid.
How does alcoholism affect individuals and families?
Alcohol is often termed as a family disease, because it affects every individual in the family. You’ll neglect important duties, need more time to nurse hangovers, display disorderly conduct and use family resources to feed your addiction. A child who was exposed to alcoholism at a young age (an alcoholic parent, for example) might grow up to abuse alcohol themselves. Children may falsely believe they’re the cause of mood swings originating from alcohol and experience guilt, self-blame, anger and frustration. Therapy treatment in rehab is usually required to help the entire family unit recover.
How easy is it to get sober?
Getting sober from alcoholism is not easy, especially if you’re a long-term user. The only way to reduce pain and discomfort associated with withdrawal is to receive detox treatment at a medically-supervised detox facility, where addiction specialists will provide the best care that aids your recovery from alcohol addiction.
Can I get sober on my own?
Many people are able to quit alcohol abuse on their own – by detoxing ‘cold turkey’, tapering off or attending 12-step programmes or support groups. The best option is determined by the duration of your drinking and your living situation, as well as mental and physical health issues that might complicate the detox process.
Is treatment available for alcoholics?
Yes. There are several treatment options for alcoholism. Firstly, you’ll begin with detoxification, where you rid your body of toxins, after which you can either attend rehab as an inpatient or outpatient to tackle problems that led to alcohol abuse and learn effective coping strategies that help you maintain long-term sobriety post-rehab. You’ll be given medication such as Naltrexone and Campral to reduce cravings and painful withdrawal symptoms. Post-rehab, there are group therapies, Alcoholics Anonymous meetings, SMART Recovery and other support programmes that motivate you to stay sober.
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