Rotherham Community Drug and Alcohol Team...• Black coffee cures a hangover • A liquid lunch...

Help yourself packRotherham Community Drug and Alcohol Team

RDaSH

Drug and Alcohol Services

This pack is designed to give you information and guidance about your alcohol use and treatment. Our service is here to help but cannot be there 24 hours a day so this pack is used in conjunction with our support to arm you with the tools to stay focussed and ‘help yourself’ to achieve your goals.

2 | Help yourself pack

Contents

Alcohol facts 04

Alcohol myths 06

Alcohol truths 06

Alcohol guidelines and benchmarks 07

Unit guidelines 08

Tips for tackling alcohol use 08

Managing urges 09

Safe coping skills 11

High risk situations / triggers 13

Strategies for challenging negative thoughts 14

Alcohol detoxification 17

Antabuse (disulfiram) information 21

Cycle of change 22

Drinks diary 23

Decisional balance (pros and cons) sheet 25

Goal setting 26

Useful numbers 27

www.rdash.nhs.uk | 3


So what is alcohol?

Alcohol is a drug, like heroin, cannabis and cocaine. The obvious difference between alcohol and other drugs is that alcohol is legal. The harm caused by alcohol is often under-rated. It has been shown that the misuse of alcohol causes much more damage in society than all the other illegal drugs put together.

Alcohol is a depressant drug meaning that it dulls the working of the brain. Depressant drugs may make you lose some of your inhibitions and also lower your ability to do co-ordinated movements, like driving a car. It is a common myth that alcohol is a stimulant; this is because it may feel like a stimulant at first but this effect is only short lived.

What happens when you drink alcohol?

After drinking alcohol it travels to the stomach where about one fifth of it is absorbed straight into the bloodstream (it doesn’t have to be digested). The rest of the alcohol is absorbed through the small intestine through and into the

blood. It only takes a few minutes after alcohol is consumed for it to be in all parts of the body.

There are various factors that slow down or speed up the rate at which alcohol is absorbed into the bloodstream, affecting how quickly you begin to feel the effects of the alcohol. If you drink on a full stomach the alcohol will travel through your body more slowly than if you had not eaten. If you have not eaten, the alcohol will be absorbed faster and you will get intoxicated quicker. The bubbles in champagne and other sparkling wines speed up the passage of alcohol into the bloodstream so you feel the effects more quickly.

How does my body get rid of alcohol?

Less than one tenth of the alcohol you take in is eliminated through the urine and breath. The remaining nine tenths has to be burnt up by the body in a process known as ‘oxidation’. Unlike other food substances, alcohol can only be burnt up (oxidised) in the liver. This explains why the liver is one of the first parts of the body to suffer from excessive drinking.

The liver oxidises alcohol very slowly, taking about one hour to burn up one unit (see the end of this leaflet for what a unit is) of alcohol, roughly equal to half a pint of average strength beer or a single 25ml measure of whisky.

Because the body breaks down alcohol at such a slow rate, it results in alcohol remaining in your body long after you have finished drinking. Depending on how much you have had, you can still fail a breathalyser test 24 hours after you have stopped drinking. You need to be very careful about driving if you have drank that day or the previous night as you may still have alcohol in your body. The legal drink drive limit cannot be accurately converted into a number of units so it is advisable to avoid alcohol if you want to drive.

The amount of alcohol in your body known as your ‘Blood Alcohol Concentration’ (BAC) depends on many factors such as how much you have drunk, your gender, size and weight. If you are smaller and lighter you will have more alcohol in your body per kilo. Drink for drink, alcohol has greater effect on a woman than a man. Women are generally smaller

and lighter, their bodies contain less water and their metabolism is different so they need less alcohol to get the same effect.

Alcohol related illness

As alcohol affects almost all organs in the body, there are more than 60 different disorders associated with alcohol use, not to mention the social cost to the drinker, families and friends. Some of these are listed below;

• Coronary heart disease

• Stroke

• Dementia

• Cirrhosis of the liver

• Liver, colon, rectum, breast cancer

• Stomach ulcers

• Pancreatitis

• Alcoholic hepatitis

• Fatty liver.



Myths about alcohol

• Once you have slept alcohol off, you are fine to drive

• Black coffee cures a hangover

• A liquid lunch will keep you slim

• The best cure for a hangover is ‘hair of the dog’

• People who drink red wine tend to live longer

• Alcohol warms you up.

And now for the truth

• It takes one hour for your liver to remove one unit of alcohol (see end of this booklet for ‘unit’). So if you drink heavily in the evening you may still be over the drink drive limit the next morning

• Only time can remove alcohol from your bloodstream, no amount of black coffee, cold showers or fresh air will sober you up.

• Alcohol is high in calories with no food value. You can put on weight and be short of nutrients

• More alcohol will only continue putting strain on your liver. Your body needs time to readjust.

Be kind to your body and avoid alcohol for 48 hours.

• Small amounts of alcohol (one to two units) can help protect against coronary heart disease but only if you are male and over 40 or if you are a woman who has been through the menopause.

• Alcohol may give you an immediate feeling of warmth after drinking because of raised pulse and blood pressure but this actually takes heat away from the body.

What type of drinker am I?

Alcohol is something to be enjoyed and most of the time, drinking doesn’t cause any problems. But drinking too much at the wrong time can be harmful.

Some people don’t drink at all or drink very rarely, perhaps at a birthday celebration. Others may drink only at weekends or a few times a week, perhaps with a meal or as part of a night out. Then there are those who drink heavily every day and those who ‘binge’ or get drunk on a regular basis.

Whether you identify with one of these drinking types or feel somewhere in between, it is down to you to see if your drinking causes you or others a problem.

Daily benchmarks for sensible drinking and units

Alcoholic drinks contain varying amounts of pure alcohol. The alcoholic strength of the drink is labelled on the bottle or can with a number e.g. 5% vol or 5%alc./vol. This is known as the Alcohol By Volume (ABV).

This ABV figure also tells you the number of units in a litre, for example, if a bottle is labelled 7%, that means there are 7 units in a litre. A can of 440ml is near enough half a litre so the number of units in that can is about half what it says for the ABV, in this case, it is 3.5 units. A bottle of wine is three quarters of a litre so if it says 11%, then the bottle has about 8 units.

THE HIGHER THE PERCENTAGE, THE STRONGER THE DRINK!

Benchmarks are a guide to what is safe for you to drink. They are not targets to drink up to. There are times and circumstances when it makes sense not to drink at all like when you have liver problems or operating machinery.

The benchmarks do not apply to young people who have not reached physical maturity.



Recommended unit guidelines for safe alcohol consumption

Try having a day off between drinking to let your liver recover (it takes 48 hours) and you should try not to drink a lot in a short space of time.

MEN should ideally not drink any more than 3-4 units a day or they could be putting themselves at risk of significant health risks, this equates to no more than 21 units in a week.

WOMEN should ideally not drink any more than 2-3 units a day or they could be putting themselves at risk of significant health risks, this equates to no more than 14 units in a week.

Top tips for tackling your alcohol use

• Structure your day to keep on track and connected to the world

• Think of the consequences of your alcohol use

• Notice the cost - what will it cost you if you keep drinking?

• Accept yourself and others - don’t try to change what you can’t

• Praise yourself! Congratulate yourself for your achievements

• Focus on today - take one day at a time

• Take responsibility for yourself and your actions (good and bad!)

• Commit to your goals - promise yourself to stick to your goals

• Learn from slip ups, setbacks are not failures, just learning experiences

• Tolerate your feelings, whether pleasant or unpleasant, feelings won’t harm you

• Get healthy! Find yourself healthy alternatives

• Find support - it’s easier with support from others

½ pint beer, lageror cider

3.5%abv

v. small glass (125ml) wine

8%abv

pub measure(25ml) spirits

40%abv

small glass (50ml) fortified wine

20%abv

• Get in control - shape your own destiny!

• Say no to negative influences, you are well within your rights to assert yourself and make healthy choices.

Techniques for controlled drinking• Have something to eat before

drinking

• Have days off from drinking

• Go out later

• Take less money

• Practice refusing drinks

• Avoid rounds (or if you are in a round, don’t buy yourself a drink)

• Avoid salty foods such as crisps and peanuts as they make you thirsty

• Try non and low alcohol wines, beers and ciders

• Change where you drink

• Avoid spending time with heavy drinkers

• Drink a long soft drink first or when you are thirsty

• Have a ‘spacer’- non-alcoholic drink between alcoholic drinks

• Get support from a friend or relative

• Don’t stand at the bar, sit down and enjoy your drink

• Drink for enjoyment

• Sip your drink

• Put your drink down between sips

• If you drink shorts, try diluting them

• Avoid drinking alone

• Do something while drinking such as pool, darts or reading

• Try and drink at the same pace as the slowest drinker.

Managing urgesNo one said controlling your drinking is easy, it takes time and practice. Try some of these tips for managing your cravings and see which ones work best for you.

Urge surf; your craving will go eventually, some may take longer than others but they will. Imagine riding the urge like a wave so you are on top of it until it hits the beach

Mental grounding; this is a technique that is very effective in detaching yourself from the urge.



You are looking outward, not inward for example;

• Describe where you are in detail; I see a blue wall, I hear a car outside, describe textures, smells, colours, shapes and try not to comment on how you feel about what you see

• Play categories for example, think of types of dogs, cars, TV programmes or songs etc

• Describe an everyday activity in detail e.g. washing dishes, cooking your dinner

• Imaginary games; skating away from the urge, build a mental wall between you and the urge

• Count backwards in 7s starting from 114

• Read something backwards

• Imagine your craving as a ball that can be crumpled or set alight and burnt, as a wind to blow your craving away or water to run down a drain

• Imagine a stop sign in the colour of your choice and focus really hard on it.

Physical grounding; this involves focussing on your body

• Run cool or warm water over your hands

• Touch objects around you

• Carry something in your pocket that is comforting

• Dig your heels in the floor

• Jump up and down or do some physical exercise such as running

• Notice your body; sit on a chair and notice the weight of your legs on the chair, your buttocks on the seat and feet on the floor. Wiggle your toes

• Walk slowly and notice each footstep

• Eat something and notice the flavours

• Focus on your breathing; put your hand just below your belly button and breathe into it moving the lower muscles. Notice each breath and keep it slow and calm.

Walk away from the urge - distract yourself from your thoughts, get active, watch a film, call a friend, go shopping, walk the dog, do some studying, make plans for the future, add up how much money you have saved from not drinking and make plans as to how you will spend it etc.

Safe coping skills

Use this sheet to pick skills you would use to help you deal with high risk situations. Get your worker to help you with the skills you would like to develop.

Skill What it is about When may I use it? How will I use it?Ask for help Getting support from

others can help you achieve your goals

Get inspired Carry / pin up something to remind you why you are doing this

Leave a bad scene

Get out when things go wrong

Keep trying Don’t give up, you can do this

Be honest with yourself

Lying to yourself is what you used to do

Let yourself be sad

There are feelings you have covered up, expressing them can help you deal with them better

Keep your self respect

Do things you like and want to do that you know will help you

Take care of yourself

Eat well, exercise, pamper yourself, be kind to yourself

Find meaning Review who you are doing this for and what you believe is right for you

Do the best you can

Nothing and no one is perfect so make the most of what is on offer



Keep yourself safe and watch for danger

Stay out of situations which may hurt you physically and emotionally

Talk yourself through it

Self talk can be helpful

Be imaginative Find different healthy ways to help you cope

Pace yourself One step at a time, there is no rush

Try to understand others

Put negative energy to better use and focus on what you can do to help yourself

Try another way If one way doesn’t work, try another!

Alone may be better

Being alone is better than being in a bad relationship / friendship

Get organised make plans, make lists, keep things tidy

My own high risk situations

Triggers are what make us desire (and often carry out) a certain behaviour. Think of situations which fit these types of times when you have been or would be more likely to drink. By identifying our triggers we are able to learn how to manage our behaviour and achieve our goals.

Below is a list of examples and space for you to write down what you have identified to be your triggers. Making changes is an ever evolving process so you may find that your triggers change over time.

Trigger Does this apply to me?

What can I learn from identifying this trigger?

Withdrawals

(people often drink to get rid of the upleasant experience they have when withdrawing from alcohol)

Physical

(are you using alcohol to take away physical pain?)

Mental

(are you drinking to numb the pain of a bad experience in the past or to deal with difficult day to day situations?)

Peer pressure

(do you feel it is difficult when others around you are drinking alcohol, do you have difficulty saying no?)



Strategies for challenging negative thought patterns

Decatastrophising – are you over reacting? Are you over-generalising?

Often events are much less catastrophic than you automatically think.

What is the worst that could happen?

How likely is it that this will happen?

What could you do to manage the event if the worst were to happen?

Positive mental attitude – Be kind and encourage yourself!

Pessimism can be a self fulfilling prophecy (you could encourage the situation to turn out as bad as you feared). Try saying positive statements such as ‘I know this is tough but I am strong and I can do this’ ‘I can change, nothing is written in stone, I am worth the effort I am going to’. Learn to love yourself, there may be people who love us but you can only truly rely on yourself to be kind to you.

Blame the event, not yourself or others – try not to personalise mistakes.

Mistakes you make are not permanent reflections on yourself and are good learning opportunities to ensure things are different next time for example if someone is horrible to you, perhaps they have had some bad news and they didn’t mean it, if they did mean it then get in control and make the choice to remove yourself from their company.

Stay focussed! – stay on task!

Doing something proactive to help you achieve your goals will make you feel better

Focus on happy things – focus on the positive

What things have gone well recently?

What do you like about yourself?

What makes you smile?

Avoid ‘shoulds’ and ‘musts’

If you find that your thoughts are full of these types of words then it probably means you are setting unreasonable demands on yourself or others for example, ‘I should be alcohol free by now’. Removing these words from your thoughts can take off the pressure and allow you (and others) more freedom to be realistic rather than feeling resentful and angry.

Re-label your distress

Negative thoughts and feelings don’t always mean you are going to end up drinking. Think of these times as signals or signposts to use your coping skills to turn the situation around.

Think outside the box – is there only one side to the story/ view of the situation?

Sometimes we can get so wrapped up in our opinions that we are blinkered to other explanations, realising this can take off the pressure and reduce the intensity of your feelings.

Congratulate yourself!

Acknowledge when you have done something right!

There are periods in everyone’s lives where we feel anxious or out of control.

When things get tough ask yourself these 7 questions

• Am I predicting the future negatively?

• What is the evidence for and against this idea?

• How would someone I admire react to this situation?

• Am I making things worse than they are?

• Does feeling this way help me feel better?

• Does it matter if things don’t turn out right?

• Am I analysing this situation too much and being irrational?



Write below how you feel after reading and answering these questions

Detoxification is an option if you are alcohol dependent

Alcohol dependence and withdrawal symptoms

If you are alcohol dependent you have a strong desire to drink alcohol. In addition, your body becomes used to lots of alcohol Therefore, you may start to develop ‘withdrawal’ symptoms 3-8 hours after your last drink as the effect of the alcohol wears off. So, even if you want to stop drinking, it is often difficult because of the withdrawal symptoms.

Withdrawal symptoms include: feeling sick, trembling, sweating, craving for alcohol, and just feeling awful. Convulsions occur in a small number of cases. As a result, you drink alcohol regularly and ‘depend’ on it to prevent these symptoms. If you do not have any more alcohol the withdrawal symptoms usually last 5-7 days, but a craving for alcohol may persist longer.

Delirium tremens (‘DTs’) is a more severe reaction after stopping alcohol. It occurs in about 1 in 20 people who have alcohol withdrawal symptoms about 2-3 days after their last drink. Symptoms include: marked

tremor (the shakes) and delirium (agitation, confusion, and seeing and hearing things that are not there). Some people have convulsions. Complications can develop such as dehydration and other serious physical problems. It is fatal in some cases.

What is detoxification?

Detoxification or ‘detox’ involves taking a short course of a medicine which helps to prevent withdrawal symptoms when you stop drinking alcohol. The most commonly used medicine for detox is chlordiazepoxide.

Detox with the help of your family doctor

Many family doctors are happy to prescribe for detox from alcohol. A common plan is as follows.

• A family doctor will prescribe a high dose of medication for the first day that you stop drinking alcohol

• You then gradually reduce the dose over the next 5-7 days. This usually prevents, or greatly reduces, the unpleasant withdrawal symptoms



• You must agree not to drink any alcohol when you are going through detox. A breathalyser may be used to confirm that you are not drinking

• Your family doctor or practice nurse will usually see you quite often during the time of detox

• Also during detox, support from family or friends can be of great help. Often the responsibility for getting the prescription, and giving the detox medicine is shared with a family member or friend. For example, a partner or parent of the person going through detox.

How will I feel going through detox?

Some people manage quite easily, others find it more difficult. You can expect to:

• Feel quite nervous or anxious for a few days

• Have some difficulty with getting off to sleep for a few nights.

• Have some mild withdrawal symptoms, but they should not be too bad, and a lot less than if you were not taking the detox medicine.

The medication used for detox does not make you stop drinking. You need determination to stop. The medication simply helps you to feel better whilst your body readjusts to not having alcohol. Even after the period of detox you may still have some craving for alcohol. So you will still need willpower and coping strategies for when you feel tempted to drink.

Vitamin supplements

You are likely to be prescribed vitamins, particularly vitamin B1 (thiamine), if you are alcohol dependent. Especially during detox. This is because many people who are dependent on alcohol do not eat properly and can lack certain vitamins. A lack of vitamin B1 is the most common. A lack of this vitamin can cause serious brain conditions.

Detox with the help of other health professionals

Some people are referred to a specialist drug and alcohol unit for detox. This is usually better for people who have other physical or mental health problems and for those who have:

• little home or social support

• a history of severe withdrawal symptoms

• a physical illness caused by alcohol

• had previous attempts to stop alcohol and have failed.

The medicines used to detox in specialist units are much the same as family doctors prescribe. However, these units have more staff and expertise for giving support and counselling. Some people with serious alcohol related problems are admitted to hospital for detox.

After detoxification and staying off alcohol

After a successful detox, some people go back to drinking heavily again at some point. To help to prevent a ‘relapse’ you may be offered medication or other help.

Medication

You may be advised to take a medicine for several months to help you keep off alcohol.

• Acamprosate is a medicine which helps to ease alcohol cravings

• Disulfiram is another medicine which is sometimes used following a successful detox. When you take disulfiram you get very unpleasant symptoms if you drink any alcohol (such as flushing, vomiting, palpitations and headache). So, in effect, the medicine acts as a deterrent for when you are tempted to drink. It can help some people to stay off alcohol .

Other help

It is thought that you are less likely to go back to drinking heavily if you have counselling, or other support to help you to stay off alcohol. Your doctor, practice nurse, or local drug and alcohol unit may provide ongoing support when you are trying to stay off alcohol. Self-help groups such as Alcoholics Anonymous have also helped many people to stay off alcohol.



If you do go back to heavy drinking, you can always try again to stop or cut down. Some people take several attempts before they stop drinking, or keep within the safe limits, for good.

(www.patient.co.uk)

Patient Information leaflet

Antabuse®, Tablets 200mg

Read this information leaflet carefully before you start the treatment with Antabuse® tablets.

What does the drug contain and what does it look like?1 tablet contains: Active ingredient: Disulfiram 20 mg. Other ingredients: Lactose, potato starch, gelatin, microcrystalline cellulose, polysorbate 20, tartaric acid, colloidal anhydrous silica, sodium bicarbonate, maize starch and magnesium stearate. Available in packages of 50 tablets. Identification: The tablet is white and scored with breakline marked “DUMEX” “110 L” on the side.

How does the drug act?Disulfiram is an alcohol deterrent and is used as a supportive agent in the treatment of alcoholism. When you drink alcohol it is metabolized in the body to acetaldehyde. Disulfiram blocks the enzyme, which breaks down acetaldehyde. This leads to an increased level of acetaldehyde in the blood provoking a series of unpleasant physical effects.

License holder and manufacturer / information is available fromThe license holder and manufacturer for Antabuse® is Dumex-Alpharma A/S, Dalslandsgade 11, DK-2300 Copenhagen S, Denmark. Information is available from the distributor Dumex Ltd, Tring Business Centre, Upper Ickneild Way, Tring, Herefordshire HP23 4JX.

What is the drug used for?Antabuse® is used to deter persons from drinking alcohol. It is prescribed in the treatment of persons with drinking problems. If you are treated with Antabuse® and drink alcohol you will experience a series of unpleasant physical reactions. This reaction may be sufficiently unpleasant to dissuade you from consuming alcohol.

When should I not use the drug?1. If you ever have a rash or allergic reaction to Disulfiram or Antabuse®.2. If you suffer from one or more of the following diseases; severe heart

disease, hypertension, and a severe psychiatric disease.3. If you have had a stroke.

If any of the above points apply to you, or you are not sure, tell your doctor.



Cycle of Change’ … related to substance use

Prochaska and DiClemente

This model describes the stages that we go through when making changes. Below is an explanation of the stages, which one do you think applies to you?

The model has 7 stages:

• Pre-contemplation - the person does not see any problem in what they are doing.

• Contemplation - the person is ambivalent - they are in two minds about what they want to do

• Decision - they have decided to do something and are getting ready for the change.

• Action - they have made the change

• Maintenance - the change has been integrated into the person’s life and they are continuing to uphold the change

• Lapse means to drink again

• Relapse is a full return to the old behaviour.

Using an alcohol diary

A drinks diary may help you to keep an accurate record of your alcohol intake in order to make and monitor changes, without doing this, people can often have a misconception about how much alcohol they are really drinking. You are going to know a lot more about yourself if you keep an alcohol diary.

Write in:

• The number of units you drank

• What it was you drank

• Where you drank

• The feelings you had before drinking

• The feelings you had after drinking

• What you did when you were drinking

• Who you drank with.

Alcohol diaries are a really good way of identifying patterns in drinking and encourage ‘conscious’ drinking (making you aware of your drinking.) for example, do you only drink when your friends do? Are you drinking because of feeling alcohol withdrawals such as shakes or sweats? Or are you really only drinking 5 cans? Identifying patterns or habitual behaviour is the starting point to changing those habits or patterns.

Try filling in this alcohol diary or make your own to suit you, remember to be as honest as you can to make the exercise worthwhile.



Alcohol Diary

Day of the week

Drink? Amount? Feelings before?

Thoughts before?

Feelings after?

Thoughts after?

Total units (see unit explanation sheet):

Decisional balance sheet

This sheet is useful for 3 reasons:

• If you list all the pros, that then tells you what you get out of your drinking (pros) and the downsides (cons). This may help you decide what you want to do about your drinking

• If you have decided that you want to do something about your drinking, then the pros and

cons will help you stay focussed on your aim. It will tell you what will be better by changing

• It tells you what you need to do differently to reduce your drinking by listing the things that you get out of it. Of course there are things you get out of drinking that you will not miss because they are caused by the alcohol, like withdrawals.

Pros of drinking Cons of drinking

Pros of change (stopping / reducing) Cons of change (stopping / reducing)



Goal setting!

Fill in this sheet to help you focus on what you want to achieve and how you are going to do it!

What do I want to achieve?

How am I going to achieve it?

What timescale do I want/need to work to?

Useful numbers

Rotherham Drug and Alcohol Services 01709 447210

Primary Care Alcohol Service 01709 447216

Drinkline 0800 917 8282

Alcoholics Anonymous 0845 769 7555

Al-Anon Family Groups 0207 403 0888

The Samaritans 0845 790 9090

Family Life 0808 800 2222


RDaSH

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geta p p r o v e d

DP5698/10273/04.13

This information is correct at the time of publishing Last Reviewed: April 2013

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