Dry January: Dr Pauline Grant – More Preparations for Dry January

Guest blogger Dr Pauline Grant continues to prepare for Dry January…

Alcohol holds an amazing place in society. A drug lauded and embraced by so many and yet for large numbers of people in the world, a dangerous cliff over which they fall. When they do so the society which encouraged them to drink turns on them and condemns them for their excess and weakness.

The government also has this 2 faced approach; refusing to do anything which may reduce alcohol consumption in the country overall, whilst complaining about NHS and police resources being used up for those who abuse alcohol. There is no acknowledgement of the link between everyday drinking and falling into addiction. I have been personally involved with many who misuse alcohol. Some recognise it as a useful drug with which to blot out past experiences and become quickly addicted, but others slip down the slippery slope through a route of gradual habituation. Climbing up a slippery slope is a lot harder than sliding down it.

The rates of liver disease in young women are rising as a direct result of increased alcohol consumption. I remember an advertising campaign showing drunk young women with vomit in their hair, which I thought was very powerful, attacking the image of alcohol. Being plastered, or gazeboed as Micheal Mackintyre would say, is not cool and should not be promoted as such.

So for those everyday drinkers like me who have not yet fallen into addiction, despite what my family may be saying, Dry January is an opportunity to stand back and reflect! and climb a little way back up the slippery slope.

Dry January: Dr Pauline Grant – Preparation for Dry January

Guest blogger Dr Pauline Grant describes her preparations for Dry January…

So I have just done 48 hours without any wine and it was pretty easy, although I do have the whole of Christmas and New year to look forward to; not really the same as the whole of January with only dark nights and nothing to look forward to. You can afford a bit of self denial when you know excess is just around the corner.

Having said that, since I have decided to sign up to dryjanuary and started the blogging and self analysis, I have started to moderate and feel that I will probably not overdo it next week. On reading my blog and my poem my eldest daughter said I sounded like a raving alcoholic, which has helped.

My strategy for January? Buy lots of nice grape juice and pretend it is wine. The kids are excited because they can see the quality of their mealtime drinks improving considerably. Not buying any alcohol, even for the others. Reminding myself of the physical benefits, reduced breast cancer risk, reduced weight and therefore reduced diabetes risk (first degree relative has it). Give the liver a rest. Saving the money I would have spent, worked out to be £60-£80 if you include trips out to the pub Although I will have to take off cost of soft drinks so only £40. Buy myself a plant for the garden with the money, something with alcohol in the title? Rosa brandy wine? Is there one?

Pauline Grant

See Pauline’s original Tumblr post here
@paulinegrant1

Dry January: Dr Pauline Grant signs up

Guest blogger Dr Pauline Grant explains why she is taking part in Dry January…

I have just agreed to take part in dry January. A worthy campaign designed to get people to think about their alcohol intake and to show them that life doesn’t have to revolve around alcohol.

Like many doctors, I drink a little too much. Actually, according to guidelines for recommended daily limits for women, a lot too much. The medical profession have a tendency to drink more than they should. Medical students need to let their hair down as an antidote to all that studying and doctors use alcohol to relax after a busy and often emotionally traumatic day on the wards or in surgery. I have not met any doctors recently who would admit to smoking but drinking too much is still seen as acceptable.

I don’t like getting plastered but drink to the point where I feel clever, witty and beautiful, and so do all my friends. The food is delicious, the ambience perfect and the evening could stretch on forever …But later on I wake with palpitations in the night and unable to get to sleep. It usually takes 3/4 of a bottle of wine to get to this stage. It used to be a lot less but that is tolerance for you. Like my patients I am experiencing more of the side effects of the substance and less of the joy.

Most evenings we drink 1/2 a bottle of wine each with dinner. Pasta needs wine; steak, fish and curry all require alcohol to be complete. In fact the only food I can think of which is not improved by alcohol is omelette. We drink on Fridays to celebrate, on Sundays to commiserate and any day if it has been a bad day, or any happy day. Which adds up to any day!

Some days I plan to have an alcohol free day but frequently break this promise to myself. I have tried cutting down to one glass of wine with dinner instead of two, which I can do half of the time. I am aware that I spend my working life exhorting patients to cut down their alcohol intake (to be fair, theirs is from 6 litres of white lightening to 5 litres so not quite the same), but am struggling to do the same myself.

So how will I achieve this gargantuan task of not drinking anything for the whole of January? Given also that hubby has refused to take part. I do however buy the alcohol, so he’ll have to buy his own. I need to lose some weight, motivating factor perhaps? There will be the shame of failing, now that I have told the whole world I am going to do it. How about a reward? Ooh, I know, a bottle of champagne!?

Pauline Grant

See Pauline’s original Tumblr post here
@paulinegrant1

 

Dry January: Can you stay off the booze for 31 days?

Lauren Booker of Alcohol Concern sets out the stall for the “Dry January” campaign. SMMGP’s Clinical Lead, Steve Brinksman and other team members are gearing up to take part!

Imagine what the UK would look like if we all took a month off alcohol next January. Imagine having fewer people in your waiting room or the local A & E department.

Well we’re a long way off from this sort of scene but as Alcohol Concern launches its Dry January campaign for the second year, the charity has an ambitious target of getting at least 10,000 people to sign up to go dry with us for 31 days in January.

About Dry January

The aim is to start a new conversation about alcohol, to get people thinking and talking about their drinking and ultimately to inspire behaviour change following a positive and fun filled month of sobriety! This year more than 80% of people who we surveyed who were taking part in Dry January said they’d drink less during the rest of the year as a result of their experience.

To build on this we’ll be conducting academic research with the help of Sussex University as part of next year’s campaign. We’ll track the impact of having a month off on people’s drinking behaviours. We feel positive that we’re going to see some good results over the next few years.

We are absolutely clear that this challenge is not a detox or for those with dependency issues and should never be promoted as such. It’s aimed at the huge number of people who are steadily drinking a bit too much, too often. And there’s plenty of us at it, 10,000,000 people in the UK are drinking over recommended guidelines and the health implications of this can be seen on almost every ward of every hospital up and down the country.

Why GPs should encourage their patients to give Dry January a go

GPs are on the front line, every day you see patients who are drinking at above recommended levels and whose visit may be alcohol related. We’re not talking about ‘alcoholics’ here, we’re talking about social drinkers. In fact up to 20% of patients presenting to general practice settings will be consuming alcohol at harmful or hazardous levels which means on average each GP will see 364 excessive drinkers a year that’s 7 a week.[1]

Dry January can be a step in the right direction for these patients. Many of the people who took part with us last year told us they hadn’t realised the bad habits they had picked up, that they were simply responding to all of the many triggers which can lead a person to picking up a drink without really thinking. Interestingly many people said they took part to prove to themselves that they could last the whole month. Most people were pleasantly surprised by how easy they found it.

Almost all of the patients coming to see a GP would benefit from Dry Jan and here’s why:

  • Cold and flu season – drinking won’t aid recovery and can disturb sleep
  • Alcohol can negatively interact with medication
  • Alcohol contributes to anxiety, low mood and depression and Dry January is a great opportunity to encourage patients to look at lifestyle issues that may be affecting their wellbeing
  • New Year’s resolutions – making a commitment and signing up to Dry January should help people to stick to their goal. We’ll also be offering regular, online support
  • Cutting out alcohol can help people towards any weight loss goals
  • Over 10% of high blood pressure in men is alcohol related.

Dry January fits in with alcohol identification and brief advice (IBA): information acquired from the AUDIT screen can be used to suggest to patients that they could give the challenge a go. If you’re using the FRAMES model for guidance for brief advice you can use this to encourage patients to give Dry January a go.[2]

You can also take an informal approach if you have a patient you think might benefit. So, if practice staff find it difficult to raise the subject of alcohol, Dry January is a great way of bringing up the topic in a gentle, non-threatening way. It’s a universal campaign, not targeted and not an intervention so it doesn’t look like you’re singling anyone out. The way I like to put it is “if you think it’ll be easy to give up alcohol for 31 days, then there’s no reason not to. If you think it’ll be hard, then it’s probably a good idea to give it a try.” Honesty, it really works!

GPs should lead by example

You knew this was coming didn’t you? It’s not just your patients who will benefit from Dry January, you can too, and ideally you’ll be leading the practice by example! We’re already working with a number of GPs who are backing the campaign. They’ve all signed up to take part as they want to lead the way in starting a new conversation about alcohol. So why not take the challenge at your practice and get everyone involved, from your receptionists to your health visitors. It will be easier to promote to others if you’re doing it yourself.

And please consider fundraising for Alcohol Concern. We’re a very small charity, 12 of us in all, with a huge job on our hands if we’re to change the drinking culture of this country. We recommend raising money to keep you stay committed and show your patients that you’re taking it seriously. Why not have a fundraising board at the practice where each member of staff writes a paragraph on why they’re doing it, to spread the word; if you’re digitally inclined tweet and blog about it; encourage patients to contribute and share their reasons for going dry.

This year we’ll also be conducting academic research to assess the long term impact and benefits of having a month off alcohol. We think there will be plenty of positives for all sections of society from people going dry for a month.

So there you have it, we would warmly welcome your company for Dry January 2014 and please encourage your patients to do likewise. Sign yourself, staff and patients up at the surgery from November 15th at www.dryjanuary.org.uk. Join in the conversation by following us on Twitter, @DryJanuary and liking us on Facebook.com/DryJanuary.

Here’s to a happy New Year.

 


[1] Anderson, 1993

[2] www.nice.org.uk/nicemedia/live/13001/48984/48984.pdf page 47 for information [accessed 25/10/13]

Every Step

Dr Steve Brinksman writes the regular “Post-its from Practice” articles for Drink & Drugs News (DDN) Magazine. The most recent Post-it (Dec-2013) appears below with kind permission from DDN.

If you have read this column before, you will know that I am always keen to promote recovery, defined by the individual in respect of their own journey and not from a political or ideological concept. That said I am reasonably long in the tooth and having worked with people who use heroin for 20 years I am well versed in the concepts of harm minimisation, and the truism “dead people don’t recover” springs to mind. Harm reduction is the solid foundation on which we can build future recovery.

With this in mind the treatment system I operate within in Birmingham has now started actively encouraging service users to undergo training in the administration of naloxone for the treatment of suspected opioid overdose, alongside placing the person in the recovery position and calling an ambulance. I have been told that “people in treatment shouldn’t need prescriptions for naloxone”; yet I have come across people in treatment who have used naloxone to reverse overdose in people outside of the treatment system, and I am sure we would all accept that despite people’s best intentions use on top of a script occurs. There have been enough uses of naloxone in Birmingham now that I can be confident that there are people alive today, who would not have been, were it not for the availability of naloxone.

To back this up there is growing evidence from around the world that it is not only clinically effective, but that it can be safely administered by peers and reduce overdose deaths. Our service users have embraced this, but in a system with a large number of GPs operating in a community setting, it is proving more of a stumbling block to get these clinicians involved, a vital step if prescriptions are to be issued. Talking to colleagues around the UK shows that we are not alone in this.

There are a number of ways to try and address this, The National Treatment Agency [NTA] supported a number of pilot sites and in 2011 produced a report recommending this – “The NTA overdose and naloxone training programme for families and carers” (PDF).

The Medicines and Healthcare products Regulatory Agency (MHRA) has just announced a consultation on a proposal to allow wider access to naloxone for the purpose of saving life in an emergency. The consultation runs until 7 February 2014 and is available online.

At SMMGP we recognise that lack of knowledge and training are significant factors that hold clinicians back from adopting new treatment approaches and so we have committed to develop a free to access e-module that will cover the rationale behind naloxone prescribing as well as the practical aspects.

We also need those of you who work with clinicians, those who commission services and those who provide education to recommend the prescribing of naloxone. Drug related deaths from overdose remain a significant problem and I believe a widespread roll-out of naloxone could significantly reduce this. We have as much a duty of care to people who use, as we do to those at any stage of their recovery.

– Dr Steve Brinksman
Birmingham GP, SMMGP Clinical Director, RCGP Regional Lead in Substance Misuse for the West Midlands

Note: Previous Post-its from Practice can be found in the Resource Library on the main SMMGP web site.