- Introduction to alcohol and drinking
- Alcohol and the hospital emergency department
- What to do in an acute intoxication situation
- Talking to your doctor about your alcohol use
- Alcohol abuse and dependence
Alcohol is the most widely used psychoactive, or mood-changing, recreational drug in Australia.There is a large spectrum of alcohol use and associated problems in Australia, some of which may not appear as though they are obviously related to alcohol. Supporting those with alcohol use problems, whether it be alcohol abuse or dependence, risky alcohol behaviour, injury from alcohol or alcohol poisoning, has obvious benefits. These benefits extend beyond the individual to their families, work places and society.
If a friend or a member of your family is using alcohol in a risky fashion, then their alcohol problem needs to be addressed by a doctor.
It is important that members of the general public know how to recognise when a person is intoxicated and how to help them if the situation arises.
In the US, up to 31% of people who go to the emergency department (ED) test positive when screened for alcohol problems. It is not known what percentage of ED presentations in Australia are associated with alcohol, but they are likely to account for a large proportion.
When people go to the ED, the hospital staff will address the alcohol-related presentation according to the individual characteristics of the person, such as:
- Severity of their condition (e.g. resuscitation may be required);
- Nature of their complaint (e.g. if they have an injury);
- Whether the problem is obviously related to alcohol; and
- Whether the person is under an immediate life-threat.
The hospital staff will need to ask questions about alcohol consumption to help understand, treat and evaluate the emergency. If the person has consumed alcohol, this will affect the treatment used, so it is extremely important for this information is given to emergency staff honestly.
Adolescents have a smaller physique, lower tolerance for alcohol and prefer to drink spirits, which makes them more susceptible to acute alcohol emergencies. Alcohol poisoning in adolescents is serious and can lead to death. 90% of Australians between the ages of 15 and 16 have consumed alcohol, and 29% reported they have been intoxicated. A study conducted in western Sydney determined that at least once every 9 days, a child or adolescent went to the ED with acute intoxication or poisoning. A recent study has determined that 56% of poisoning admissions to the ED by under-18-year-olds were due to acute alcohol intoxication.
There is a common perception amongst parents that when their child or adolescent is taken to the emergency department with alcohol intoxication, it is a result of normal teenage “experimentation”. While this is true in many cases, it can also be an indicator of more serious psychosocial problems.
Studies have reported that adolescents with alcohol abuse or dependence are up to 12 times more likely to have a history of physical abuse and up to 21 times more likely to have a history of sexual abuse. Alcohol abuse also leads to problems with functioning at school.
It is important to identify children and adolescents who are frequently consuming “risky” amounts of alcohol to prevent adverse outcomes, further abuse and untreated mental health problems.If your child has had an alcohol-related problem or has been treated in the ED, you should take them to a doctor to screen for more serious problems. The doctor may take the following actions:
- Comprehensive alcohol and drug assessment;
- Assessment of psychosocial risk factors;
- Assessment of treatment history; and
- Arrange appropriate follow up to ensure the alcohol-related problem is under control.
When a person becomes intoxicated, they are more likely to get into dangerous situations. Depending upon the amount of alcohol consumed, an intoxicated individual is 2–10 times more likely to have an injury. Excessive amounts of alcohol can cause death through its depressant effect on the respiratory centre of the brain. For this reason, it is important not to just label an intoxicated individual as a “drunk”, because in some cases it can be a serious and life-threatening issue.
Helping an intoxicated individual can be challenging. Often, the person may be confrontational, argumentative and uncooperative. The individual may also be emotionally unstable and require some emotional support. While it is important to help an intoxicated person stay safe, the first priority must always be your personal safety. If an intoxicated individual becomes violent, then you should leave the scene and call the police.
The first important step for helping in an acute intoxication situation is to be able to recognise the signs and symptoms of intoxication, take observations and make an assessment regarding the severity of the situation. Signs include:
- Alcohol odour coming from their skin or clothing;
- Coordination and troubles balancing and walking;
- Slurred speech and difficulty conversing;
- Nausea and vomiting; and
- Flushed face.
Seizures can result from alcohol intoxication or from the withdrawal of alcohol for people who are dependent. If the seizure is believed to be due to alcohol intoxication, it is important that the person be treated medically – call an ambulance. The Poisons INformation Centre for your state or territory can provide additional information.
There are little steps that can be taken to help an intoxicated individual avoid serious health consequences as a result of too much alcohol. You can help by:
- Continually monitoring the person who is drunk. If you do not know the drunk person, you can ask if you can call anyone to come and get them. If inside commercial premises (e.g. a restaurant or bar), ensure any staff are aware that the person is drunk;
- Check and monitor the breathing of the person who is drunk;
- Make sure the intoxicated person does not slip from sleeping to unconsciousness by waking them often. The blood alcohol concentration (BAC) can rise even when someone has stopped drinking alcohol – this means that “sleeping it off” is not safe;
- Ensure the intoxicated individual is sleeping on their side with a pillow behind them to prevent them from rolling on their back. This will prevent them from choking on their vomit.
- Never let one drunk person look after another drunk person.
- Never allow an intoxicated individual drive a car, swim or ride a bike.
If the intoxicated individual vomits continually, displays irregular slow breathing, cool pale skin or loses consciousness, it becomes an emergency situation and an ambulance should be called immediately.
Alcohol is a toxin and, if drunk in excess in a single occasion, it can lead to alcohol poisoning. Alcohol poisoning can be life-threatening and is an emergency situation that requires help from medical professionals. An ambulance should be called if a person is displaying symptoms of alcohol poisoning. Symptoms of alcohol poisoning include:
- Mental confusion;
- Stupor or coma;
- Slow breathing (fewer than eight breaths per minute);
- Irregular breathing (10 seconds or more between breaths);
- Hypothermia; and
- Bluish skin colour and paleness.
In extreme cases of nervous system depression, complete respiratory support may be necessary. Once an ambulance has been called, first aid will optimise health outcomes for the intoxicated individual.
If alcohol poisoning goes untreated, there are a number of effects that lead to serious health consequences, including potential permanent brain damage or even death. Consequences of alcohol poisoning include:
- Choking on vomit;
- Breathing can stop;
- Heartbeat can stop;
- Hypoglycaemia, which can lead to seizures; and
- Severe dehydration from vomiting, which can also lead to seizures, permanent brain damage or death.
Drinking is very common in Australia, with 9% of people drinking daily and 41% drinking weekly.Heavy drinking will often go undetected by your doctor during routine physician examination if you are not there for an obvious alcohol-related issue. It has been estimated that over two thirds of drinking problems are undetected in hospitals and general practice. Therefore it is important to tell your doctor about your alcohol consumption – even if you do not think you drink too much. This is especially important if:
- Your doctor is prescribing a medication. Some medications may interact with alcohol which can cause drug toxicity or stop your medication from working;
- You are pregnant or trying to conceive;
- You tend to drink heavily and smoke,
- You are the parent or guardian of adolescents or young adults and you are worried about their drinking habits or the way your drinking habits may be affecting them;
- You have health problems that might be related to alcohol. This includes cardiac arrhythmia, indigestion, liver disease, depression or anxiety, insomnia and trauma;
- You are not responding to treatment as expected. It may be because of alcohol consumption. This can include treatments for chronic pain, diabetes, gastrointestinal disorders, depression, heart disease and hypertension.
Once your doctor is aware of your drinking habits, they are better able to treat you. If they believe you are drinking too much, they can provide you with options to help you change your habits. If you have already tried to change your habits before, your doctor can help you to find a different way to help cut down.
Alcohol dependence can be diagnosed when a person experiences any three of the following symptoms concurrently:
- The compulsion to drink;
- Loss of control while drinking;
- Alcohol tolerance;
- Alcohol takes priority over all other activities;
- Withdrawal symptoms are experienced; or
- The person keeps on drinking despite recognised harm.
If you suspect that you or someone you know has developed an alcohol dependency, it is very important that medical advice is sought. People who see a doctor for help to cut down on their alcohol consumption may benefit from the following:
- Your doctor will help you work out a drinking goal. It may take time to completely cut down, so it may be helpful to gradually cut down by setting weekly goals;
- Some people may benefit from seeing an addiction specialist;
- Some people may benefit from seeing a mutual help group; and
- For people highly dependent on alcohol, detoxification and medically-managed withdrawal may be necessary.
|For more information on alcohol problems, see Alcoholism (Alcohol Dependence).|
For more information on drinking alcohol, including drinking disorders and alcohol’s effect on the body, as well as some useful tools, see Alcohol and Drinking.
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