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Alcohol Our Favourite Drug: The big picture: can nurses and midwives make a difference?

Alcohol Our Favourite Drug: The big picture: can nurses and midwives make a difference?. Prof. Jim Rankin Ist International Alcohol, Tobacco and Other Drugs Nursing & Midwifery Conference Adelaide, April 16, 2003. Advances in Knowledge and Understanding: Alcohol - Before 1960.

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Alcohol Our Favourite Drug: The big picture: can nurses and midwives make a difference?

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  1. Alcohol Our Favourite Drug:The big picture: can nurses and midwives make a difference? Prof. Jim Rankin Ist International Alcohol, Tobacco and Other Drugs Nursing & Midwifery Conference Adelaide, April 16, 2003

  2. Advances in Knowledge and Understanding: Alcohol - Before 1960 • Alcoholism a moral problem or a manifestation of mental illness • Alcoholism a disease - Alcoholics Anonymous

  3. The Scene 1964: Treatment Services • Completely inadequate • Psychiatric hospitals • Residential • Custodial care • Inmates: • Inebriates’ Act • Psychiatric complications • Temporary accommodation & support

  4. Sister Mary Christina Wellsford, RSC

  5. Advances in knowledge and understanding of alcohol problems • A spectrum of drinking behaviours that may cause problems • A spectrum of alcohol-related problems • A spectrum of responses involving health promotion, prevention and intervention/treatment

  6. Broadening the base of treatment: • Establishment of services in general hospitals • Shift of resources from psychiatric hospitals to community-based services • Shift of resources to provide a balance of residential and non-residential services • Initiatives to increase the involvement of general practitioners

  7. Responding to alcohol problems in Australia: potential resources • Medical practitioners 70,000 (est) • Addiction medicine specialists • Certified 140 • Certification pending 60 • Registered nurses 250,000 (est) • Registered midwives 67,000 (est) • Members of DANA 200+ • Number of D & A services 2000 (est)

  8. VISION

  9. The role of nursing and midwifery

  10. A whole of profession responsibility Practitioners • Clinical nurses • Nurse educators/academics • Nurse managers • Nurse researchers Organisations • Registration bodies • General professional organisations • Academic organisations • Alcohol and drug

  11. A Vision of Nursing and Midwifery Professions that play active roles in the development and implementation of comprehensive alcohol policies and programs for prevention and treatment

  12. A Vision of Nursing and Midwifery: Prevention and Health Promotion Professions whose members incorporate into their professional activities strategies and practices that have as their objectives maintenance of abstinence and safe patterns of alcohol use, and reductions in hazardous and harmful use.

  13. A Vision of Nursing and Midwifery:Clinical Care Professions whose members play a complementary role to these preventive strategies by • identifying and intervening with their patients whose are at risk because of their alcohol use; and • Identifying and responding to the health needs of their patients who already have alcohol-related damage

  14. Topics • Drinking patterns in Australia and their consequences • Effects of alcohol on health • Prevention, intervention and treatment • Potential roles of nursing and midwifery • Systems’ impediments to progress

  15. Drinking Patterns in Australia Population aged 14+ years % • Drinkers 811 • Hazardous/harmful drinkers 351 • Hazardous/harmful drinkers 142 Population aged 14-19 years • Drinkers 641 • Hazardous/harmful drinkers 671 Aboriginal & Torres Strait Islander Peoples • Drinkers 621 • Hazardous/harmful drinkers 821 1 = Last 12 months 2 = Last week

  16. Deaths Caused 4,286 Prevented (7029)1 Total (2,744) Note 1. 94% aged 60+ years Hospital beddays Caused 394,417 Prevented2 (255,433) Total 138,974 Note 2. 79.7% aged 60+ years Alcohol-attributable deaths and hospital bed days, 1998-9

  17. Potential benefits of policies designed to prevent alcohol misuse Preventable deaths 4,286 Preventable hospital beddays 394,417

  18. Social costs of drug abuse, 1998-9 $m % Alcohol 7,560.31 22.0 Tobacco 21,063.0 61.2 Illicit drugs 6,075.8 17.6 Total 34,439.8 100.0 Avoidable costs of alcohol misuse $3,928.6m (62.1%) Note 1. Costs of alcohol misuse 1.98% of GDP

  19. Effects of alcohol on health

  20. Factors in Acute Alcohol-related Damage Acutealcohol consumption

  21. Factors in Acute Alcohol-related Damage Acutealcohol consumption • CNS depression: • Impairment of • Motor function • Coordination • Judgment • Respiration • Consciousness

  22. Factors in Acute Alcohol-related Damage Acutealcohol consumption • CNS depression: • Impairment of • Motor function • Coordination • Judgment • Respiration • Consciousness Motor vehicles Workplace Hotels & bars Other social venues Sporting activities Associated drug use Drinking Circumstances and Environment

  23. Factors in Acute Alcohol-related Damage Trauma Acutealcohol consumption • CNS depression: • Impairment of • Motor function • Coordination • Judgment • Respiration • Consciousness Motor vehicles Workplace Hotels & bars Other social venues Sporting activities Associated drug use Drinking Circumstances and Environment General Environment

  24. Trauma • Fall injuries • Road injuries • Occupational and machine injuries • Fire injuries • Drowning • Assaults • Suicide

  25. Factors in Acute Alcohol-related Damage Acutealcohol consumption • CNS depression: • Impairment of • Motor function • Coordination • Judgment • Respiration • Consciousness Overdose/poisoning Motor vehicles Workplace Hotels & bars Other social venues Sporting activities Associated drug use Drinking Circumstances and Environment General Environment

  26. Overdose/Poisoning • Acute ethanol overdose and poisoning • Aspiration • Combined alcohol and drug overdose and poisoning • Methanol poisoning

  27. Factors in Acute Alcohol-related Damage Acutealcohol consumption • CNS depression: • Impairment of • Motor function • Coordination • Judgment • Respiration • Consciousness Obstructivesleep apnoea Motor vehicles Workplace Hotels & bars Other social venues Sporting activities Associated drug use Drinking Circumstances and Environment

  28. Factors in Acute Alcohol-related Damage Acutealcohol consumption • CNS depression: • Impairment of • Motor function • Coordination • Judgment • Respiration • Consciousness Pregnancy Sexual assaultChild Abuse Motor vehicles Workplace Hotels & bars Other social venues Sporting activities Associated drug use Drinking Circumstances and Environment

  29. Factors in Acute Alcohol-related Damage Supportive HOME ENVIRONMENT Non-supportive Privileged SOCIAL CLASS Under-privileged Affluence INCOME Poverty Very good COMMUNITY SERVICES Absent Very good HEALTH SERVICES Absent General Environment

  30. Factors in Acute Alcohol-related Damage Trauma Acutealcohol consumption • CNS depression: • Impairment of • Motor function • Coordination • Judgment • Respiration • Consciousness Overdose/poisoning Obstructivesleep apnoea Pregnancy Sexual assaultChild Abuse Motor vehicles Workplace Hotels & bars Other social venues Sporting activities Associated drug use Drinking Circumstances and Environment General Environment

  31. Effects of Long-term Alcohol Consumption Long-termalcohol consumption

  32. Relationship between alcohol consumption and cirrhosis mortality, Ontario 1928-1972

  33. Effects of Long-term Alcohol Consumption Long-term alcohol consumption Alcohol a necessary cause of diseases

  34. Alcohol a Necessary Cause of Disease Behavioural and Neurological • Alcohol dependence • Acute alcohol withdrawal • Delirium tremens • Acute alcoholic hallucinosis • Alcoholic polyneuropathy • Alcoholic cerebellar atrophy • Neuro-psychological impairment • Wernicke-Korsakoff syndrome

  35. Other diseases: Alcoholic gastritis Alcoholic hepatitis Alcoholic cirrhosis Alcoholic cardiomyopathy Foetal alcohol effects Foetal alcohol syndrome Alcohol a Necessary Cause of Disease

  36. Effects of Long-term Alcohol Consumption Long-termalcohol consumption Alcohol a contributing cause of disease

  37. Alcohol a Contributing Cause of Disease Cancer • Oropharyngeal • Oesophageal • Laryngeal • Liver • Female breast

  38. Alcohol a Contributing Cause of Disease Gastro-intestinal and hepatic • Oesophageal varices • Gastro-oesophageal haemorrhage • Unspecified cirrhosis • Haemochromatosis • Acute pancreatitis • chronic pancreatitis

  39. Alcohol a Contributing Cause of Disease Other diseases: • Epilepsy • Hypertension (males) • Ischaemic stroke (males) • Haemorrhagic stroke (males) • Psoriasis • Depression, attempted suicide and suicide • Spontaneous abortion

  40. Effects of Long-term Alcohol Consumption Long-termalcohol consumption Alcohol a contributory factor to disease outcome

  41. Alcohol a Contributory Factor to Disease Outcome • Hepatitis C • Pulmonary infection • Post-operative complications

  42. Effects of Long-term Alcohol Consumption Long-termalcohol consumption Alcohol a protector from diseases

  43. Alcohol a Protector from Disease • Ischaemic heart disease • Hypertension (females) • Supra-ventricular cardiac dysrhythmias • Hear failure • Ischaemic stroke (females) • Haemorrhagic stroke (females) • Cholelithiasis

  44. Effects of Long-term Alcohol Consumption Long-termalcohol consumption Alcohol a necessary cause of diseases Alcohol a contributory cause of diseases Alcohol a contributory factor to disease outcome Alcohol a protector from diseases General Environment

  45. Prevention & Treatment of Alcohol-related Problems:A Spectrum of Problems and Responses The goal: Harm minimization

  46. Advances in disease prevention & health promotion • Drinking Guidelines • Low alcohol content beers • Labelling of alcoholic beverage containers with the number of drinks • Drink-driving counter measures ▬ Random breath testing ▬ Zero blood alcohol levels for probationary drivers

  47. Advances in disease prevention & health promotion • Thiamine supplementation of flour • Indexation of alcohol taxes • Initiatives to reduce alcohol-related harm in and near licensed premises

  48. Advances in clinical management • Screening instruments (AUDIT) • Assessment instruments • Effective behavioural interventions • Motivational interviewing • Cognitive behavioural restructuring • Brief interventions • Pharmacotherapies: • Naltrexone • Acamprosate • Management of alcohol-related physical diseases

  49. Changes in alcohol problems • Between 1988 and 1998 per capita consumption as fallen from 9.4 to 7.5 litres • Australia has fallen from 12th to 19th place internationally in per capita consumption • These declines associated with falls in: • Incidence of alcohol-related road injury and deaths • Total alcohol-caused mortality • Deaths where alcohol is the sole cause • Deaths where alcohol is a contributing cause

  50. Prevention and Treatment of Alcohol-related Problems:A Spectrum of Problems and Responses Alcohol Use Safe Primary prevention Nil

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