alcohol forum national conference 2014

‘ALCOHOL’S HARM TO OTHERS’When their drinking becomes your problem!

Alcohol Forum National Conference 2014

This Conference is part of Alcohol Awareness Week, March 31st- April 4th 2014Check out the Events Calendar on www.alcoholforum.org

Welcome & Opening Address

Conference Chair - Mr. Denis BradleyExecutive Chair Alcohol Forum – Mr. Pat Harvey

National Conference:

Alcohol’s Harm to Others,

‘When their drinking becomes your problem!’

Ministerial Address Junior Minister for Health

Mr. Alex White TD




Professor Robin RoomDirector of the Centre for Alcohol & Policy Research,

University of Melbourne.

“Harm from Others’ drinking: an important part of societal harms

from alcohol”




Alcohol’s Harm to Others: Building a Knowledge Base, and Considering

Implications for Policy

Robin RoomCentre for Alcohol Policy Research, Turning Point Alcohol & Drug Centre;

Melbourne School of Population & Global Health, University of Melbourne;

Centre for Social Research on Alcohol & Drugs, Stockholm University

Presented at an Alcohol Forum National Conference: Alcohol’s Harm to Others, at the National Conference

Centre, Dublin, 2 April, 2014

Alcohol consumption

Volume Patterns Quality

Health outcomes

Incidencechronic conditionsincluding AUDs

Incidence acuteconditions

Mortality bycause

Societal Factors

Drinking culture

Alcohol Policy

Drinking environment

Health care system

Population group

Gender

Age

Poverty Marginalization

(individual)

Let’s start from alcohol’s roles in the health of the drinker

(looking under the lamp-post) -- the story is complex

Chronic diseases – “NonCommunicable Diseases” (NCDs);Infectious diseases; Mental disorders; Injuries

Population group

Comparing health harm to the user, different risks in the Global Burden of Disease, 2010 (Lim et al., 2012, corrected)

“Harm from other people’s drinking is common and wide ranging. It ranges from the less severe, such as being kept awake at night by rowdy behaviour or covering up for a colleague who fails to turn up for work, through to much more severe consequences, such as domestic violence, assault or neglect of children.”

--Safe, Social, Sensible: The next steps in the Alcohol Strategy , UK Dept. of Health, 2007

But the health of the drinker is not the only issue

Intrinsic harmfulness: ratings by psychopharmacologists

Nutt et al., Drug harms in the UK: a multicriteria decison analysis. Lancet 376:1558-65, 2010.

• The drinker in the household or family– Money for household expenses used for drinking– A spoiled holiday celebration– A child left stranded when a drinking parent fails to pick them up

• The drinking friend or workmate– Worktime lost or diverted because of a coworker’s drinking– Injury while restraining an intoxicated friend ready for a fight

• The drinker on the street or in a public place– An injury or death from someone’s drink-driving– Physical abuse or threats from someone who’s drunk– “No-go” areas because of threatening drunks

What is alcohol’s harm to others? Some examples....

Concentric domains of harm to others

Family Household

Friends

Workmates

Strangers

Much of drinking’s harm to others is interactive, in major social roles

From the perspective of the “other”: harm from drinkers in family, friend, work roles; and from strangers

From the perspective of the drinker: harm from one’s own drinking in family, friend, work roles; and to strangers

Missing in the duality: Collective harm (e.g. to productivity, to social cohesion) mostly outside both frames

Four frames for measuring alcohol’s harm to others

• The viewpoint of the drinker– Population surveys of problems from drinking

• The viewpoint of the “other”– Survey on harm to the respondent from others’ drinking

• As noticed by official agencies responding to problems– Agency records data – police reports, welfare agencies, etc.

• As included in economic studies of the social costs of alcohol – Using combinations of data – including agency records data and survey

data Population surveys on drinking have focused primarily on adverse

consequences of drinking for the drinker, not for those around the drinker Social cost of alcohol studies have focused primarily on costs for governments

and for the drinker, except for some coverage in drink driving and crime

A particular gap in adverse effects on the family -- for instance as noted in the UK Prime Minister’s Strategy Unit

report on social costs of alcohol in England & Wales

The “costs of alcohol” tradition• “negative externalities” = harm to others

-- Direct costs ≈ costs of social handling in societal response institutions (health, police, welfare…)• In a welfare state, mostly not out of pocket of family

-- Indirect costs: lost production because of early death or disability• Financial loss to family, and distress

-- Intangible costs (usually unmeasured, not counted in): • Includes: potential loss of quality of life when living with a problem drinker

• Economists’ peculiarities-- Tendency to treat the household as a unit-- “Transfer costs” not counted

• So:• “harms to family/social networks” not costed in --

Study report, published 2010: http://www.fare.org.au/wp-content/uploads/2011/07/The-Range-and-Magnitude-of-Alcohol%E2%80%99s-Harm-to-Others-report.pdf?9d7bd4 Co-authors: Anne-Marie Laslett, Paul Catalano, Tanya Chikritzhs, Caroline Dale,

Christopher Doran, Jason Ferris, Ansari Jainullabudeen, Michael Livingston, Sharon Matthews, Janette Mugavin, Robin Room, Morgan Schlotterlein & Claire Wilkinson

Collaborating institutions Centre for Alcohol Policy Research, Turning Point Alcohol & Drug Centre National Drug Research Institute, Curtin University, WA National Drug and Alcohol Research Centre, UNSW

An Australian national study of alcohol’s harm to others

http://www.fare.org.au/wp-content/uploads/2011/07/The-Range-and-Magnitude-of-Alcohol%E2%80%99s-Harm-to-Others-report.pdf?9d7bd4



The Range and Magnitude of Alcohol’s Harm to Others

• How many are affected?• In what ways are they affected or harmed?

• Who are affected?

• What is the relationship between them and the drinker?

• How deeply are they affected? Who needs help or care?

• What are the costs of drinking for others around the drinker -- in trouble, in time, in money?

Deaths 367 Hospitalisations 13,669 Child protection cases 19,443 Domestic assault police cases 24,581 Assaults – public places, etc. 44,852

Hospital costs, crash injuries $30m Hospital costs, assault victims $59m Child protection system costs $672m

Findings from official registers: severe effects in 2008 from others’ drinking (of 21.3 million population)

29% negatively affected at least a little in last year 9% negatively affected a lot Young women 18-29 most likely to be adversely affected (43% at

least a little) Young men (27%) and middle-aged women (35%) also more likely

to be affected Types of effects: lost time spent cleaning, caring for, transporting

the drinker, emotional hurt and neglect, serious arguments, failure in social roles and financial effects, break ups (and staying elsewhere)

Negative effects of problematic drinkers among family or friends

Drinker’s gender: male 71% Drinker’s average age: 40 years

For respondents aged 18-29: 29 years Average number of standard drinks

when drinking heavily 13 drinks Average number of days in a week that the drinker consumes 5+ standard drinks 4 days

-- drinkers with adverse effects on others drink quite a lot

Among family/friends: characteristics of the drinker with the greatest adverse effect in the

last year

70% report one or more negative effects from strangers’ drinking in the last year

40% negatively affected at least a little 4% affected a lot Young adults 18-29 most likely to be affected (females

61%, males 57%) Types of effects: annoyed by vomit, urination or littering,

experienced property damage, serious arguments, threats, physical abuse

Negative effects of drinking by strangers

Tangible Intangible TotalCollins and Lapsley

In 2004/5 dollars 10.8 4.5 15.3Inflated to 2008 dollars 12.1 5.0 17.1

…Alcohol's Harm to Others reportFull estimate (p.178) 14.2 6.4 20.6Without overlap withCollins and Lapsley 12.6 6.4 19.0

Adding non-duplicate costs(the two bolded rows) 24.6 11.4 36.0

Adding in the costs to others: harm from others’ drinking (out-of-pocket expenses, time spent, reduced quality of life)

doubles the conventional societal cost estimate -- in billions of dollars (AUD) per year

Australians are likely to have heavy drinkers among their relatives and friends

The percentage of respondents who reported a heavy drinker for each relationship category, and average number of heavy drinkers (HD) for each relationship category, 2011 reinterview, by gender

(N)

Male Female Total (458) (645) (1,106)

% reporting HD in household (HH)a 9.4 12.6 11.2 Average no. HH HDs 0.10 0.14 0.12

% reporting HD (non-HH) relatives and intimates (R+I)

24.2 31.6 28.6**

Average no. R+I HDs 0.35 0.44 0.40* % reporting HD in HH and non-HH R+I 29.9 38.6 35.0**

Average no. HH and non-HH R+I HDs 0.45 0.58 0.52* % reporting HD among friends 39.7 30.4 34.3**

* Average no. friends HDs 1.86 1.15 1.44** % reporting HD among co-workers 18.6 11.3 14.3**

Average no. co-worker HDs 0.96 0.45 0.66* % reporting any known HD among respondent

62.5 60.3 61.2

Average no. HD overall 3.37 2.31 2.75**

HD = heavy drinker, someone who is “a fairly heavy drinker, or drinks a lot sometimes. HH = household; R+I = relatives and intimate partners. Gender difference: * p < .05, ** p<.01, *** p<.001. a Household members include partner, son or daughter, parent, sibling, and non-family household members.

Harm from the drinking of those you know is more likely when you know a lot of heavy drinkers

Harm from drinkers: bivariate predictors, 2011

Harm from:

Known problematic drinkers

Strangers

Sex

Male

1(Ref) 1(Ref)

Female

1.40* 1.09 Age

18-35

1(Ref) 1(Ref) 36-55

0.93 0.94

56 and over

0.57* 0.49*** Heavy drinkers among:

Household members 5.55*** 1.35 Relatives and intimate partners 3.50*** 1.41*** Friends 1.13*** 1.12*** Co-worker 1.02 1.05*

p < .05, ** p<.01, *** p<.001. N=1,096

Parallel survey study done in New Zealand World Health Organization stream of work under the

Global Strategy on Alcohol WHO/ThaiHealth collaborative study in low- and

middle-income countries: Thailand, Vietnam, Laos, India, Sri Lanka, Nigeria, Chile

Full studies planned in Brazil, US, Canada Summary studies done in Ireland, Scotland, Nordic

countries, Further work proposed as an emphasis in new

GENACIS (Gender, Alcohol & Culture) studies -- loose coordination through International Group on Studies of Alcohol’s Harm to Others

Looking globally

Beginning on international comparisons: a first “crosswalk” of 18 “assessment” items

Type of Items Harm to Others Sample Size # 18 12 Sweden 7 n n 15576Finland 6 n n 1931Norway 5 n n 1947Iceland 6 n n 1372Scotland 16 n y 1007Ireland 6 n n 1069Denmark 13 n y 5133Thailand 18 y y 1695Laos 18 y y 1320Vietnam 18 y y 1500Chile 18 y y 1524Nigeria 18 y y 2000Sri Lanka 18 y y 1650India 18 y y 2800Australia 16 n y 2469New Zealand 15 n y 3068Brazil 18 y yUSA 13 n y

Speculations: comparing “second-hand smoking” and “second-hand drinking”

Damage to others: For smoking: an order of magnitude less than to

the smoker For drinking: in the same order of magnitude as to

the drinker Why so little and so late an emphasis for

alcohol? (An exception: drink driving)

Why so little and late an emphasis for alcohol?

The effects are not confined to health – brings in other professions and institutions; effects are often immediate rather than delayed

Heavily moralised territory (e.g., violence against women, child abuse) focus on individual responsibility and away from environmental/population perspectives

The long shadow of the temperance era (particularly in Anglophone countries)

2+ generations of reaction against temperance, “I’m not a wowser”

Particularly in public health, since PH and temperance paradigms were so close

How to present the findings on harm to others? Pointing to public health rather than punitive individualistic

approaches?

In a society with customary alcohol drinking, harms to others from drinking are substantial

In cost terms, about as big as the harms to the drinker Serious harms from others’ drinking in the workload of all

societal emergency response agencies Police, ambulances, hospital EDs, child protection services ...

When less serious harms are taken into account, much of the population is adversely affected

Often a heavy burden of harm for family members Friends, workmates and strangers are also harmed

Implications for policy and community action - 1

Alcohol policy is not just about protecting drinkers from harm to themselves – it’s also about protecting others

Decisions on alcohol policy should take the interests of those around the drinker into account

Programs to strengthen community responses should be tested and implemented: “You don’t have to put up with it!”

Implications for policy and community action - 2

Professor Moira PlantDirector of the Alcohol and Health Research Unit & Professor of

Alcohol Studies, University of the West of Britain.

“Alcohol Harm during pregnancy:Fetal Alcohol Spectrum Disorder”




Mr. Joe Doyle National Planning Specialist, National Social Inclusion Office HSE

“Responding to the recommendations in the Steering Group Report on a

National Substance Misuse Strategy”.




Dr Ann HopeDepartment of Health & Primary Care, Trinity College

“Alcohol’s Harm to Others in Ireland”, 2014




Alcohol’s Harm to Others in Ireland

Dr Ann Hope,Research Associate,Department of Public Health and Primary Care, Trinity College, Dublin.

Alcohol Forum National Conference National Conference Centre Dublin, April 2nd, 2014

Context - International• Main focus to date –

harm to the drinker• WHO 2010 – Alcohol’s

harm to others (AH20) from drinking requires special attention

• International Group for Studies of Alcohol’s Harm to Others (IGSAHO)

Ireland

Some evidence of AH20

Irish info – alcohol’s harm to others

• Road crashes– For every one road fatality, 8 serious injures occur (Road

Safety Authority)

• Sexual assault (rape cases)– Drinking to intoxication featured in a high proportion of

rapes committed in Ireland (Hanley et al 2009)

• Domestic violence– One-quarter of domestic abuse cases involved alcohol

(Watson & Parsons 2006)

• Self-harm/suicide– Alcohol related self harm peaks in July/Aug (Arensman NSRF,

AAI Conference 2013)

• Alcohol related crime– Murders, assaults, domestic abuse, vandalism, public

disorder (Steering Group Report 2012)

. . . . Irish info – AH20

• Children– One in eleven children said that parental alcohol use

affected them in a negative way (ISPCC 2010)

– Over half of parents with children in home are regular risky drinkers (Hope 2011)

– Parental alcohol abuse linked to child welfare issues (Roscommon Child care inquiry Report 2010)

• Adults– Six in ten people said they were negatively affected in

some way by someone else’s drinking (AAI 2011)

Doctor says alcohol implicated in 45 per cent of all suicides Speaking to the Mayo News following the inquest on his son, David (19), John Higgins said the family had been paralysed by the grief of losing their only son and brother. He described the inquest as a "big step" in trying to get over their grief, but he is calling for tighter regulation in relation to the cost of alcohol in supermarkets and off-licences. Irish Times, Nov 2011

Dangerous games • Drinking games are always dangerous. But the latest one, spawned by neknomination and carried on the social networking site Facebook, was particularly pernicious. Facebook management maintained providing a platform for a binge-drinking game involving young people was not "directly harmful" and declined to close it down. Following intense pressure, however, the creators of neknomination announced it will be redesigned as an alcohol awareness page.

The neknomination game involved young persons videoing themselves while consuming quantities of alcohol; posting the pictures online and then nominating someone else to follow suit. The welcoming link page featured large glasses of beer under the slogan:" It's not

a crime to get drunk". A warning not to break the chain came with the nominating process. This constraint was criticised as an aggressive marketing ploy, designed to exert peer pressure on young and vulnerable people. The extreme behaviour of some participants projected a "lad culture" while the public •nature of the drinking challenge raised the issue of cyberbullying. It was a particularly nasty piece of alcohol promotion. •Irish Times, Feb 2014

Rowdy students face boot in anti-social crackdownSOME of the country's biggest colleges have been challenged to expel students convicted of making local residents lives hell through repeated anti-social behaviour. . . . . . . Residents in Cork, Dublin, Galway and Limerick all complained about students whose loutish behaviour and house parties have made their lives a misery. Irish Independent, Sept 2012

Irish study AH20 - Methodology

• National Drinking Surveys 2006 and 2010 – National representative quota sample 1,000+ adults 18+

yrs– Face to face interviews

• Measures Socio- demographics – gender, age, marital status, social

classDrinking pattern - Risky drinking Frequency of risky drinking -75+grams of alcohol per occ

Regular (1+ per month) Infrequent (less than monthly), Abstainers

(75 grams equivalent to bottle of wine, 4 pints beer, 7 single measures of spirits)

H20 Measures – 3 settings

1. General population (2006, 2010), N=2,011

because of someone else’s drinking . . Have you had/been

Family problemsPassenger with a driver who had too much to drinkHit or assaulted Financial troubleProperty vandalised Involved in a traffic accident (added in 2010)

. . . H20 Measures

2. Workplace (2010) N=723

Co-workers whom you consider to be fairly heavy drinkers or who drink a lot sometimes.

because of your co-workers drinking . . . Has your ability to do your job been negatively affected? Were you involved in an accident or a close call at work?Have you had to work extra hours?

. . . H20 Measures

3. Children in Families (2010) N=680Those who had parental responsibility, whether the child lived with them or not because of someone else’s drinking were . .

Children left in an unsupervised or unsafe situation Children yelled at, criticised or otherwise verbally abusedChildren physically hurtChildren witness to serious violence in the home

Results

1. General Population

Prevalence of AH20 in general population

Over one in four

people reported

1+ harms due to

others drinking

Over one in four

people reported

1+ harms due to

others drinking

%

AH20 by gender and age

• More women report family problems

• Young women as vulnerable to assault as men (30-49 yrs)

• More women report family problems

• Young women as vulnerable to assault as men (30-49 yrs)

Those who risk travelling

with a drunk driver

tend themselves to drink at

risky levels.

%

Profile of those most likely to report harm from other people’s drinking

Controlling for gender, age, marital status, social class and drinking pattern Harms those more likely •Family problems - women, - under 50 years - lower social class

•Money problems - women - single

•Passenger with a drunk driver - regular risky drinkers

•Physical assault - men - young adults (18-29 yrs) - single

•Property vandalised - 30-49 yrs

Results

2. WorkplaceAlcohol’s harm to co-workers

Overall one in ten workers reported 1+ harms from co-workers

drinking

Overall one in ten workers reported 1+ harms from co-workers

drinking

%

Profile of workers most likely to report harm from co-workers whom they consider to be fairly heavy drinkers

Controlling for gender, age, marital status, social class and drinking pattern

Harm in workplace from co-workers drinking

Most likely - Men - Young adult workers (18-34 age group)

Results

3. Children in Families

One in ten children were exposed to

1+ harms from others drinking

One in ten children were exposed to

1+ harms from others drinking

%

One in ten children are exposed to harm from other people’s drinking

However, if parent (respondent) is also a regular risky drinker,

this is a second source of risk of harm to children

One in ten children are exposed to harm from other people’s drinking

However, if parent (respondent) is also a regular risky drinker,

this is a second source of risk of harm to children

Children most likely to experience harm from other people’s drinking

Controlling for gender, age, marital status, social class and drinking pattern

Harms

•Child left in unsafe situation Most likely - when parent (respondent) is also regular risky drinker

•Child witness to serious violence in homeMost likely - when parent (respondent) is from lower social class

International Comparisons

Irish AH20 items

with similar measures

in Scotland, Canada, USA, Australia

AH20 in Ireland in three settings

general population,

workplace,

children in families

harm is more extensive in Ireland compared to

the other countries

AH20 in Ireland in three settings

general population,

workplace,

children in families

harm is more extensive in Ireland compared to

the other countries

AH20 - Conclusion 1

• While scope of Irish study was limited• AH20 is evident across the three settings

– General population– Workplace– Children in families

• Those most at risk of AH20 – Young adults and children

• AH20 more extensive in Ireland when compared to studies in Australia and North America

AH20 - Conclusion 2

• Alcohol harm extends beyond the drinker and affects many other people

• We need to establish the scope, size and cost of H20 to Irish society– to help inform policy directions at community &

societal level (public health approach)

• Ireland needs effective policies on price, availability and marketing to reduce AH20.

Dr Michael ByrneHead of Student Health Department, University College Cork

“University College Cork, Innovative Approach to Tackling Alcohol’s

Harm on Campus”




Reducing Alcohol Related HarmAmong Our Students

Dr. Michael ByrneUCC Student Health Department

Student Health Centre Student Health Department

University College Cork

Other Tragic Consequences

So What Would You Do?

Dr. Michael ByrneUCC Student Health Department

UCC PLANNING MEETING TO PROTECT OUR STUDENTS

Sexual Health Service

Physiotherapy

Accident Prevention

Peer Support

Safer Accommodation

More Exercise Facilities

“It’s The Alcohol Stupid”

Developing and ImplementingUCC’s Alcohol Action Plan

Dr. Michael ByrneStudent Health

University College Cork

Background Story in UCC

UCC Students Policy “Drinks and Litter Monitoring Group”

Alcohol was an emerging health problem 2005 onwards

Considerable contributor to ill-health, risk to individuals

Considerable contributor to anti-social behaviour

University concerned because of Impact on Studies, Retention and Progression Rates

Reputational Risk

Health, Welfare, Support Services Concerned too.

1995 Onwards ?

Key events in UCC that led to AAP?

Adopted a Population Based Approach E-PUB UCC 2008 Orientation Presentations 2009 Research Published in Irish Medical Journal

UCC Students 2009

Alcohol and Drug Use in Students Attending a Student Health Centre

Elizabeth Cahill, Michael Byrne

IMJ Sept 2010


Adopted a Population Based Approach E-PUB UCC 2008 Orientation Presentations 2009 Research Published in Irish Medical Journal

Year of Tragedy in UCC Stronger Student Leadership Support Seminar on Alcohol NUIG 2010

Social-ecological model


Development on UCC’s 1st Alcohol Action Plan 2010-11

Incorporate Alcohol Action Plan into HPU initiative

Revision of UCC Alcohol Action Plan in 2012: Identification of 5 Key Strategy Areas

Identification of 20 Specific Action Points

Dashboard of Key Performance Indicators

Elements of UCC’s Alcohol Action Plan

5 Key Strategic Areas

20 Specific Action Points

Minister Alex White Minister of State at the Department of Health Department of Health Hawkins House Dublin 2

Dear Minister 30/10/2012

The Irish Universities Student Services Network (IUSSN) is composed of the most senior officers from each of Ireland’s Universities responsible for delivering the administrative and welfare support services to our students. A delegation from the IUSSN met with your predecessor Ms Roisin Shortall to communicate our concern about the adverse consequences being suffered by our students as a result of their harmful levels of alcohol consumption. We further wished to convey our support for the efforts underway in the Department of Health to tackle this issue. As part of this delegation, University College Cork committed to provide the Minister with up to date data on the self-declared drinking habits of its students. These data are contained in the attached report. In submitting these data University College Cork wishes to note that it believes that these data describes a situation that is unlikely to be unique to its students. Furthermore University College Cork also wishes to assure the Minister and the Department that it takes this issue very seriously indeed and has actively pursued a number of strategies to try to lessen the harm suffered by its students. These strategies are described in the attached UCC Alcohol Action Plan.

The IUSSN requests that you note the concerning data and that 3rd level students are identified as a particularly vulnerable group in the emerging National Substance Misuse Strategy. Furthermore we request that your Department and the HSE liaise with the 3rd level sector through the IUSSN, The Irish Student Health Association, and the Confederation of Student Services in Ireland to build on on-going work already underway to develop a sector-wide approach to address this concerning issue.

Yours Sincerely

20% + need high level intervention

2 Problems

1.Students don’t recognise that they need help2.No capacity to meet the demand even if they did

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Development/adoption UCC’s 1st Alcohol Action Plan 10-11

Incorporate Alcohol Action Plan into HPU initiative

Revision of UCC Alcohol Action Plan in 2012: Identification of 5 Key Strategy Areas

Identification of 20 Specific Action Points

Dashboard of Key Performance Indicators

Irish HealthCare Awards 2013 Best Public Health Initiative

An Duais Mhór; The Overall Award

Key Learning-Points from Experience

Get Senior Support

Use University/Institution Structures

Get Key individuals in Place

Get Student Support: Make it a Safety Issue

Publicise and make everyone know what you are doing

Develop a Policy and a Plan

IMPLEMENT IT REVIEW IT REPORT IT AND REVISE IT

Believe in it and Just Do It

Go on….Make a difference.

Conference Chair- Mr Denis Bradley

BREAK 11.30 – 12.00




Dr. Helen Mc MonagleAlcohol Related Brain Injury Rehabilitation Co-ordinator Alcohol Forum

“The impact of Alcohol Related Brain Injury on the Family and Society”.Launch of ARBI Care Guide




Alcohol-Related Brain Injury: Impact on Family and Society

Dr Helen McMonagle BSc. MSc. PGDip. DCounsPsychARBI Rehabilitation Coordinator

What is an Alcohol-Related Brain Injury?

•Is a term used to describe the injury or damage caused to the brain as a result of excessive alcohol intake and related nutritional deficiencies.

•A spectrum of psycho-neurological/cognitive conditions.

Functional Changes

Key cognitive skills affected by ARBI:

•Memory•Executive functions•Balance & Coordination

These can range from mild to severe.

Who’s at Risk?

• Men drinking 35 standard drinks per week or women drinking 28 standard drinks per week for 5-10 or more years.

• Admitted to acute hospital in the past year due to drinking.

• Those neglecting their nutrition.

• Those with Alcohol-Related liver damage.

• Multiple detoxifications.

• Has a close relative who has a suspected ARBI

• Oslin, D., Aktinson, R.M., Smith, D.M. and Hendrie, H. (1998) Alcohol-Related Dementia: Proposed Clinical Criteria. International Journal of Geriatric Psychiatry 13, 203-212.

National Prevalence

Autopsy Studies: 0.4% - 2.8%

Irish Estimate: 18,320 - 128,240

Harper C, Fornes P, Duyckaerts C, Lecomte D, Hauw JJ. An international perspective on the prevalence of the Wernicke-Korsakoff syndrome. Metabolic Brain Disease 1995;10:17–24.

Acute Hospitals in Ireland

• 17% of alcohol-related hospital admissions will feature varying degrees of cognitive impairment

• 84 days= Average length of stay per person in acute hospitals.

• 16 = Lost bed days at acute hospital per person.

Popoola A, Keating A, Cassidy E (2008); Alcohol, cognitive impairment and hard to discharge acute hospital inpatients. Ir J Med Sci 2008; 177:141–5.

Homelessness Population

21% of homeless hostel dwellers.

Gilchrist, G, and Morrishon, DS (2005) Prevalence of alcohol related brain damage among homeless hostel dwellers in Glasgow. European Journal of Public Health, 15 (6). Pp. 587-588

Prison Population

15-42% of prison population

“male impairment profile more resembled that seen in alcohol related brain injury- alcohol use was the main cause of brain injury among prisoners, while in the general community traumatic head injury is the most common cause”

Arbias: Acquired Brain Injury in the Victorian Prison System & Famularo-Doyle, Jo. "Homelessness, Acquired Brain Injury and Corrections Victoria." Parity 23.1 (2010): 18.

Dementia Population

10% of Dementia population = 4170 of Irish Dementia Population

12.5% of dementias in under 65'sMacRae, Rhoda, and Sylvia Cox. Meeting the needs of people with alcohol related brain damage: a literature review on the existing and recommended

service provision and models of care. Dementia Services Development Centre, 2003.

Key Challenges

Two Tier Service Response

Case Study

• Matthew – Aged 48• Longstanding Alcohol-

Dependence• Observations of

deterioration in cognitive/functional abilities over 3 years.

• Admitted to LGH

• Structured routine of activities including placement in community gardening project – 4 days per week

• Introduction of P.A

• Graduated discharge.

• Living successfully in the community. Remains abstinent

Impact on Family

• The hidden patient of ARBI

• Caregiver ambivalence

• Ambiguous loss

• Repeated difficulties accessing services

Impact on Family

• Caring for someone with ARBI is a hugely challenging process.

• But, if well supported can be mutually beneficial.

• Families need attention, education, guidance and support if they are to survive, regroup and rebuild their lives.

If you wish to receive a copy, please email: [email protected]

Get on Your SoapBox, Leading the Alcohol Debate

Each contributor is given 3 minutes to make their pitch on reducing harmful drinking in Ireland.

•Frances Black - The Rise Foundation•Michelle Savage – Founder of www.fasd.ie•Colin Regan - GAA •Pearse Finegan – Mental Health & Primary Care Project, ICGP •Frank Murray – Royal College of Physicians of Ireland




Panel Discussion

Delegate Question TimeChairman’s Closing Remarks




‘ALCOHOL’S HARM TO OTHERS’When their drinking becomes your problem!

Alcohol Forum National Conference 2014

This Conference is part of Alcohol Awareness Week, March 31st- April 4th 2014Check out the Events Calendar on www.alcoholforum.org

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