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GCA ANNUAL REPORT 200405

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GCA ANNUAL REPORT 200405 Powered By Docstoc
					   GLASGOW COUNCIL on ALCOHOL
      Tackling the misuse of alcohol


• COCAINE AND ALCOHOL

• THE HIDDEN MIXER
• 9TH OCTOBER 2006
• Alex Meikle
   GLASGOW COUNCIL on ALCOHOL
       Tackling the misuse of alcohol

• PREVALENCE LEVELS IN SCOTLAND:
• No of people in Scotland with
  problematic drug misuse levels in
  Scotland = 55,000
• No of people in Scotland estimated to
  be alcohol dependent = 276,213
  (Source: Alcohol Concern 2003)
      GLASGOW COUNCIL on ALCOHOL
            Tackling the misuse of alcohol

      THE TIERS
• Tier 1 Services – General public, prevention,
  education and awareness
• Tier 2 Services - People experiencing moderate to
  severe alcohol problems e.g. local councils on
  alcohol
• Tier 3 Services - People with severe alcohol
  problems requiring specialist help e.g. CAT
  Community Rehab
• Tier 4 Services – People with acute alcohol problems
  requiring residential care or hospitalisation
          GLASGOW COUNCIL ON ALCOHOL

• GCA is composed of five key components,
  which are:
• Prevention and education work
• The counselling services including the
  Alcohol Counselling Centre (ACC),
  Homelessness, Community Counselling and
  Young People’s counselling service
• Training (both internally and externally)
• Groupwork i.e. the ACE Programme
• East End Community Alcohol Support
  Service
  WHAT GCA DOES . . . . . . . .
      THE MANTRA!!!
ADDS VALUE TO ADDICTION SERVICES
 WITHIN GREATER GLASGOW BY:
• Keep people at Tier 2, prevent them from relapsing
  to Tiers 3 or 4 and eventually move them to Tier 1
• Assess for, signpost and fast-track for people who
  need them into Tiers 3 and 4 services
• Provide throughcare service for people coming out
  of Tiers 3 and 4 services
        GLASGOW COUNCIL ON ALCOHOL


• Cocaine use in Scotland is the third
  highest in Europe (UN report July 2006)
• 1.4% of 15-64 year olds use this drug.
• Scottish Drugs Misuse Database (2006)
  reports 8% of all presentations to addiction
  services in Scotland are using cocaine
  compared to 5% in 2000/01
• Alcohol use has remained steady at 13%
  in 2004/05 compared to 12% in 2000/01
        ALCOHOL AND COCAINE

• One study in US estimates that 75% of
  cocaine users use alcohol both
  independently and while using cocaine
• Harm from using both is greater than using
  either separately
• Treatment outcomes are different for
  simultaneous use
• Therefore, extremely important to identify
  simultaneous use
        ALCOHOL AND COCAINE

Combined bio-chemical effects:
• Alcohol leads to 30% increase in blood
  levels of cocaine if taken at the same time
  or just before
• Liver combines cocaine and alcohol to
  produce Cocaethylene which increases
  dopamine release and can lead to sudden
  cardiac death
        ALCOHOL AND COCAINE

Combined psychiatric effects:
• More euphoric and rewarding leading to an
  increased high
• Decrease in alcohol sedation or cognitive
  impairment
• Increase in interpersonal and physical
  violence
• Increase in sexual risk behaviours
• Increase in impulsive decision making and
  decrease impact on memory and learning
           ALCOHOL AND COCAINE

Consequences:
• The bio-chemical effects and the psychiatric effects
  combine with potentially disastrous consequences
• More “Bangs for your bucks”
• Less apparent effects of alcohol “I can handle this better”
• Two substances which in themselves lead to volatility in
  individuals have this factor significantly enhanced
• More impulsive behaviour
• Greater chance of heart failure and sudden death
• Treatment is more complicated as there are contra-
  effects i.e. withdrawl can be accompanied by intoxication
         ALCOHOL AND COCAINE

Conventional Scottish Treatment Characteristics
  for Service Users
• Opiate/Injecting/Alcohol users
• Poor
• Unemployed
• Depressant users
• From “Deprived backgrounds” (Dep Cats 6-7)
• Strong association with physical and mental
  health issues as well as issues such as abuse
• Addiction as manifestation of deeper issues
  therefore treatment is necessarily holistic
           ALCOHOL AND COCAINE

Treatment Characteristics for alcohol and cocaine users
• Polydrug users with no one substance in ascendancy
• Educated/Aspirational/Affluent
• Employed
• Stimulant user and risk taker with alcohol exacerbating
  the stimulant
• Classless from all backgrounds (Dep Cats 1-7)
• No necessary casual connection to other issues
• Addiction as hedonism related to lifestyle, culture,
  availability, leisure clashing with pressures of work and
  status
          CONSEQUENCES
BUT COMBINATION OF ALCOHOL AND
  COCAINE CAN LEAD TO:
• Spiral into unemployment
• Poverty
• Abuse
• Collapse of self-esteem
• Debt
• Criminal record
• Poor health
• Paranoia/anxiety/mental health issues
           ALCOHOL AND COCAINE
Case Study 1
• 37 year old male, employed
• Consumes 32-35 units in one session
• Started taking cocaine to “last the pace and keep awake”
• Cocaine stopped him feeling depressed and worrying
  about money problems that had arisen over past two
  years
• “Wished the weekend could last forever”
• Got arrested: “best thing ever happened to him”
• Rude awakening; abstinent from alcohol and cocaine for
  last five months
               ALCOHOL AND COCAINE
Case Study 2:
•    32 year old male, employed, homeowner
•    Strongly into image, appearance, suntan lounge
•    Will spend between £300 -£600 per weekend on cocaine and alcohol
•    After work on Fridays: all day drinking supplemented by cocaine taken in
     pubs and clubs
•    Will consume 116 units of alcohol over 1 weekend (up to 52 units in one
     day) and 2-3 grams of cocaine
•    “Don’t think you’re drunk, think you’re cool”
•    End up involved in fighting including broken teeth and black eyes, totally
     counter to cool image trying to project
•    On Sundays will drink to “unwind” but end up using cocaine again
•    Inevitably having problems with work: Tired, depressed and paranoid
•    Now being given alcohol counselling allied to motivational interviewing,
     stress management and anger management
       ALCOHOL AND COCAINE
Case Study 3
• 20 year old male from deprived area, unemployed
• Drank heavily along with frequent use of cocaine
• Motivating factor in taking cocaine along with
   alcohol was boredom; the combination of the two
   gave him a greater “buzz”
• Made him feel happy and upbeat about his life
• Began having seizures, which stopped
   immediately he ceased using cocaine
• Still drinking, but not as heavily
• Receiving counselling
                 ALCOHOL AND COCAINE
Conclusions:
•     These two substances in combination are potentially lethal within a relatively short
      period of time
•     It is imperative that assessment and screening picks up dependency on both; the
      conventional assessment of one primary drug and several subsidiary drugs is not
      appropriate here: this is Co-dependency
•     The client group will not normally have the typical characteristics associated
      currently with presentation at addiction services
•     Use of these two substances would appear to be increasing
•     They are used normally as part of a lifestyle and not as a response to deep
      underlying causes
•     Other problems e.g. criminal record, abuse, unemployment follow on from the use
      of the substances and not the other way around
•     Addiction workers have to be empowered and trained to deal with both substances
•     Addiction services have a major role in secondary prevention work in preventing
      alcohol and cocaine use from causing the individual to spiral further into chaos and
      more resources are needed to do this
•      Location and opening hours of services will have to be considered
•     More research has to be carried out into the combined effects of both and to treat
      them as their joint use increases