Alcohol Help

Today, the NHS have released its latest figures on smoking, alcohol drinking and drug use among young people in England.

The figures show that, across England, rates of drug taking and alcohol drinking among this age group are lower than in previous years. The proportion of secondary school pupils who drank alcohol in the week previous to the survey fell from a peak of 26 per cent in 2001 to 18 per cent in 2009, with the percentage in 2010, standing at 13 per cent. The proportion who had used drugs in the last month stood at seven per cent. In 2001, this figure stood at 12 per cent and has declined ever since.

Simon Antrobus, Chief Executive for Addaction says:

“At Addaction we’re seeing more young people successfully overcome their problems. And it is encouraging to see, from these figures, that less young people are drinking or using illegal drugs. However, the falls in these NHS figures haven’t been replicated by a fall in referrals to our services.

In fact, over the past year, Addaction has seen a rise in young people who drink alcohol problematically, and who use drugs like ketamine or mephedrone. As any parent whose child is having problems will tell you, instances of drug and alcohol misuse are still far too common.

We believe more must be done for young people like this, and for their wider families. Timely intervention, education and specialist support prevents drug and alcohol problems from escalating. Paired with support for the wider family, it means the problems underlying someone’s use are tackled properly and effectively. For example, this report shows that a parent’s alcohol drinking is a key influence on their child’s own approach to alcohol. This is why working with the whole family, as Addaction does, can be so important.

Yet our ability to provide this alcohol support is at risk. In some areas of the UK, our young people’s services’ budgets have seen cuts of up to 50 per cent. The result is a significant reduction in the support we can offer. So, while it is good to see that less young people are using drugs and alcohol, we cannot become complacent. We need to ensure that specialist support remains available for everyone who encounters problems, whether it is the person themselves or the family around them”.

Addaction

The 2010 annual survey of smoking, drinking alcohol and drug use among young people in England released today by the NHS Information Centre shows a significant reduction in young people’s involvement with alcohol, continuing an apparent trend over recent years.

The proportion of 11-15 year olds surveyed that had never consumed alcohol rose from 39% in 2003 to 55% in 2010, and the proportion of those surveyed who drank alcohol in the previous week halved from 26% in 2001 to 13% in 2010.

The survey results also record young people’s changing attitudes to drinking alcohol, with a decline in young people’s acceptance of their peers drinking and getting drunk. There is also a strong belief amongst young people that their peers’ drinking is the result of peer pressure and the desire to appear ‘cool’.

The reasons behind the changes reflected by the survey findings are probably complex, and further research will be needed to understand them more fully. The trend does, however, appear to be separate from any effect caused by changing ethnic demographics in the UK.

Some of the reasons may be:

A reaction against excessive and underage alcohol drinking as the media reveal the excesses of the weekend ‘binge culture’.
The growth of social media which allows young people that reject drinking alcohol to have the support of a likeminded peer group.
Changes in social patterns in families which make parents more influential in the attitudes of young people.
Some awareness and rejection of messages encouraged by drinks industry marketing.

However, it should be noted that there is evidence of a polarisation between young people who drink and those who do not. For those that have had a drink during the previous week, the mean amount of alcohol consumed has actually increased to 12.9 units per week from 11.6 in 2009.

Alcohol Concern Chief Executive Don Shenker said:

“The decision by some young people not to drink may be a reflection of a wider trend among young people to go against the flow and opt out of the prevalent pattern of excessive drinking among youth in the UK.

“There are already budding groups springing up online of young people who want more from life than just speed drinking until they’re sick and this is very encouraging. There may be a culture emerging with some young people of not buying into the drink industry marketing of alcohol and instead choosing to be more independent and discerning about their lifestyle.”

Alcohol Concern

In the wake of the Public Health Responsibility Deal, the Commons Select Committee for Science and Technology has announced an enquiry into the government’s health advice concerning alcohol.

The enquiry is to look into:

What evidence are the government’s guidelines on alcohol intake based on, and how regularly is the evidence base reviewed?
Could the evidence base and sources of scientific advice to the government on alcohol be improved?
How well does the government communicate its guidelines and the risks of alcohol intake to the public?
How do the UK government’s guidelines compare to those provided in other countries?

Alcohol Concern Chief Executive, Don Shenker said:

“Alcohol Concern welcomes the new enquiry by Commons Select Committee for Science and Technology looking at government guidance on healthy alcohol intake, especially in its aim to strengthen the evidence base and ensure that guidance is firmly based on scientific findings.

“We also welcome the committee’s undertaking to look at how effectively the government communicates the health risks associated with alcohol consumption, together with the role of the intake guidelines in increasing public awareness of these health issues.

“Whilst the committee’s intended comparative review of international safe drinking recommendations is of some interest, Alcohol Concern considers that up-to-date medical research should take precedence over any existing practice when considering UK guidelines.”

Alcohol Concern

Drinking beyond safe limits can damage several aspects of health

“Alcohol damages DNA of unborn children beyond repair,” The Independent reported today. The newspaper says that “scientists have identified the precise molecular mechanism” through which this damage happens.

Excessive drinking while pregnant is known to cause foetal alcohol syndrome, which can cause life-long learning disabilities, behavioural problems and sometimes physical abnormalities in affected babies. The researchers say that their current study provides a potential biological link between DNA damage and this syndrome.

The study examined the impact of various types of alcohol exposure on mice that were engineered to lack either one or two genes that are involved in the body’s ability to successfully process alcohol and repair DNA damage. These were the Aldh2 gene, involved in breaking down a toxic chemical called acetaldehyde that is formed from alcohol in the body, and the Fancd2 gene, which is involved in repairing damaged DNA. Foetal mice lacking these genes were highly sensitive to alcohol exposure in the womb, showing a reduced rate of survival and an increased rate of severe brain defects.

These results suggest that acetaldehyde-related DNA damage could play a role in the development of foetal alcohol syndrome. However, as they are based on mice lacking two important genes that help protect the body from the toxic effects of alcohol, these results may not directly represent the way that foetal alcohol syndrome occurs in humans, as humans generally have working copies of these genes. Further research will be needed to determine the role that DNA damage plays in this syndrome in humans.

Where did the story come from?

The study was carried out by researchers from the University of Cambridge and funded by the Children’s Leukaemia Trust and Fanconi Anaemia Research Fund.

The study was published in the peer-reviewed scientific journal Nature.

The findings of this study were generally reported accurately in the media, although The Independent reported that scientists had identified how alcohol induces DNA damage, saying that they had discovered “the precise molecular mechanism leading to the breakdown of the body’s natural defences”. While this study did find that alcohol increased the risk of foetal damage, this was in genetically engineered mice lacking two key genes that protect the cells from DNA damage from alcohol. Given these important genetic changes and the fact that this was a mouse study, it isn’t possible to say as yet whether DNA damage is solely responsible for causing foetal alcohol syndrome in humans, who would normally have functioning copies of these two genes.

What kind of research was this?

This was a laboratory-based study that included experiments in live mice, some of which had been genetically engineered. Previous research has confirmed that cells exhibit DNA damage when exposed to a specific compound called acetaldehyde, which is formed when the body processes alcohol. There are multiple enzymes responsible for the elimination of accumulated acetaldehydes, and researchers investigated the role of a particular set of genes in the process of protecting the body from the toxic effects of acetaldehyde build-up.

In this study the researchers looked at two genes, the first of which (Aldh2) is essential for the breakdown of acetaldehyde, and the second of which (Fancd2) has, when absent, been linked to cells’ sensitivity to the toxic effects of acetaldehyde. They sought to determine the effect of alcohol on the development of birth defects in mice that did not posses either of these two key genes, and therefore could not make the proteins for which the genes contain the instructions for producing.

This type of animal study allows researchers to study the role that specific genes play in different processes in the body. However, while animal models are useful for exploring theories and biological mechanisms, they do not always reflect what happens in humans; the way these genes work in mice may differ from the way they work in humans.

What did the research involve?

In the first phase of the study, researchers looked at the role of the Aldh2 gene (which produces an enzyme for breaking down acetaldehyde) and how it affected the survival of foetal mice which had been genetically engineered to lack the Fancd2 gene that is involved in acetaldehyde sensitivity. The aim of this phase was to examine whether foetal mice could survive when lacking these two mechanisms for protecting against the toxic effects of acetaldehyde, as this compound is not just associated with alcohol but other processes as well.

They next looked at whether or not the toxic effects of acetaldehyde were enough, on their own, to cause foetal death or developmental defects. To do this, pregnant mice carrying foetuses lacking the Aldh2 gene and the Fancd2 gene were given a dose of alcohol, and the proportion of the surviving foetal mice that lacked these genes was determined. This was compared to pregnant control mice which were given a dose of saline instead of alcohol. The aim of this phase was to examine whether exposure to alcohol altered survival in foetal mice which lacked the two genes. Differences in the presence of developmental defects were also measured.

In humans, mutations in the Fancd2 gene and other related genes involved in DNA repair cause a disease called Fanconi anaemia, which is characterised by problems in producing blood cells. Additionally, researchers say that previous research has shown that abusing alcohol is associated with the disruption of blood cell production. Based on this, researchers next looked at the effects alcohol had on the generation of blood cells in mice which did not have the Aldh2 and Fancd2 genes. They hypothesised that alcohol exposure would result in an accumulation of acetaldehyde, which would in turn disrupt the mice’s ability to produce blood cells. To do this, researchers regularly added alcohol to the mice’s drinking water and tested their levels of various blood constituents.

Lastly, the researchers examined the health of mice which lacked both the Aldh2 and the Fancd2 genes, but were not exposed to alcohol.

What were the basic results?

The researchers found that the survival of foetal mice that lacked Fancd2 was dependent on either the mother or the pup having the gene Aldh2. That is, if a pup was genetically predisposed to sensitivity to acetaldehyde, either the mother or the pup had to be able to naturally break down acetaldehyde and prevent it from accumulating in order to for the pup to survive.

The researchers examined the impact of in utero (in the womb) alcohol exposure on foetal death and developmental defects. They found that:

If pregnant mice carrying foetuses that lacked the Aldh2 gene and the Fancd2 gene were given alcohol, this reduced the proportion of foetal mice that survived to birth.
After alcohol exposure about 43% of the surviving foetal mice that lacked both genes exhibited eye abnormalities. This was higher than the rate in foetal mice that lacked both genes but were not exposed to alcohol (20%).
After exposure to alcohol, about 29% of the surviving foetal mice that did not have either gene had a specific type of severe brain abnormality. These problems were not found in the foetal mice which lacked these genes but were not exposed to alcohol.

The researchers also identified problems in blood cell production in the mice lacking these genes that were continuously exposed to alcohol in their drinking water.

When investigating the health of mice with neither gene but which were not exposed to alcohol in the womb, researchers found that:

The pups had subtle developmental defects, but initially appeared to be generally healthy.
Within three to six months, many of the pups developed illnesses with symptoms such as rapid weight loss and lethargy.
After death, the majority of these sick mice were found to have large cancerous masses in multiple organs.

How did the researchers interpret the results?

The researchers concluded that foetal mice which lacked both Aldh2 and Fancd2 are extremely sensitive to alcohol exposure in the womb, and alcohol exposure after birth in these mice is very toxic to bone marrow cells. They say that acetaldehyde-driven DNA damage may contribute to the development of foetal alcohol syndrome in humans.

They also suggest that their research raises possibilities for new therapeutic approaches to treat people with Fanconi anaemia, a disease caused by mutations in the human Fancd2 gene and other related DNA-repairing genes. Such approaches could target aldehyde chemicals in order to prevent their build-up and toxic effects.

Conclusion

This mouse study has identified a potential pathway by which alcohol, or more specifically, by-products of alcohol metabolism, can damage DNA and lead to developmental defects. It presents evidence that the chemical acetaldehyde which is formed by the body from alcohol may drive this DNA damage, and that its breakdown limits this damage. It also identifies a key DNA repair gene which helps to fix this damage.

Excessive drinking while pregnant is known to cause foetal alcohol syndrome, the effects of which can include learning disabilities and other behavioural problems, as well as physical abnormalities. It is possible that acetaldehyde-related DNA damage could be playing a role in the development of this syndrome. However, it is important to bear in mind that these results come from mice lacking two important genes that help protect the body from the toxic effects of alcohol. As most people have working copies of these genes, these results may not be directly representative of foetal alcohol syndrome in humans.

That said, this research has identified several clues that might help us understand the effects of alcohol on the body and on developing foetuses. These clues will now need to be investigated through further research, particularly through studies addressing the role that DNA damage may play in foetal alcohol syndrome.

NHS Choices

Eurocare (European Alcohol Policy Alliance) is extremely disappointed with the shape of the Food Information to Consumers legislation which exempts alcoholic beverages from obligation to list its content.

This is despite the fact that alcohol is high in calorie content, carbohydrates and certain ingredients used in its production can cause allergies or intolerances.

We strongly believe that we all have the right to make informed choices and the current proposal will mean that one will know what is in a bottle of a fruit juice but not in a bottle of alcoholic beverage.

Providing information (about ingredients and energy value per 100ml) would allow consumers to assess the quality of the beverages and keep track of their calorie intake.

Marian Skar, Secretary General of Eurocare, says: ‘We are very disappointed and concerned about the exemption of alcohol from providing information to consumers. Labelling alcoholic drinks would allow consumers to make an informed choice about their diet and health. This is a bitter reminder about the influence of the powerful industry lobbying on the politicians and their failure to give priority to interest of the people. It really makes us all wonder what is in our drinks, that the industry is so afraid to tell us’

The European Parliament’s decision is not only ignoring the health and letting people take their own informed choice but it is also not in line with EU’s previous declarations. As stated in the EU Alcohol Strategy launched in October 2006: ‘Citizens have the right to obtain relevant information on the impact, and in particular on the risks and consequences related to harmful and hazardous consumption of alcohol, and to obtain more detailed information on added ingredients that may be harmful to the health of certain groups of consumers’

European Alcohol Policy Alliance

In a new policy released this week, the Church of England removes the existing barrier to investment in business with over 25% alcohol-related turnover, and replaces it with an ethical social responsibility test.

The Church’s Ethical Investment Advisory Group (EIAG) and its investing bodies concluded that it was wrong to bar investment in every producer of alcohol while ignoring the mass retail of low-cost alcohol by supermarkets.

The group, concerned about the continuing negative health and social consequences of the misuse of alcohol, have recommended continued restrictions on investment in companies involved in the production and sale of alcoholic drinks, but taking the form of ethical criteria to which any producer or retailer deriving more than five per cent of their revenues from alcoholic drinks will be expected to comply.

This will bring general retailers such as supermarkets within the scope of the policy relating to alcoholic drinks for the first time.

Alcohol Concern Chief Executive, Don Shenker said:

“This is a very welcome move from the Church of England who have huge moral as well as economic influence over the ethical practice of supermarkets and the drinks industry. It is to the Church’s credit that they will hold the drinks industry and supermarkets to account when judging whether or not alcohol is promoted and sold responsibly. The large supermarkets must understand that while they have the right to make a profit from selling alcohol, this must be balanced with responsibility and awareness to ensure alcohol harm is minimised. It is to be hoped that the Church will lead the way for all other investment groups to scrutinise the ethical practice of the drinks trade, which unfortunately, often falls short of expectations.”

Alcohol Concern

“Drinking responsibly” is promoted by everyone from public health officials to beer advertisers, but it’s unclear how many people understand what that means.

A recent study from Sweden showed that between 94 and 97 percent of respondents did not know the line between sensible drinking and heavy drinking that can damage health.

It’s not clear that Americans would fare any better in their knowledge of the amount of drinking that threatens their health, though a comparable study has not been done in the U.S.

“In general, people are very capable of defining their drinking and giving reasonably good estimates of what they drink,” said Thomas Babor, the chair of community medicine and public health at the University of Connecticut School of Medicine. “What they are not good at estimating is what amounts of alcohol are going to do damage.”

The new study was based on survey responses from 3,200 people about their drinking and what they knew about safe levels of drinking. It was published in June issue of the journal Alcohol and Alcoholism.

How much is bad for your health?

According to the Department of Health and Human Services, moderate alcohol consumption is defined as one drink per day for a woman or two for a man. Heavy drinking is consuming more than three drinks in a day or seven in a week for a woman or more than four in a day or 14 in a week for a man. The department noted that some people should abstain completely, including people who will be driving, women who are pregnant or breast-feeding and people who cannot control their alcohol intake.

Babor explained that those limits are based on what levels of drinking have been associated with negative health outcomes, such as cancer or liver cirrhosis.

In that vein, the U.S. Department of Agriculture notes in their nutrition guidelines that while some studies show benefits to moderate drinking, “it is not recommended that anyone begin drinking or drink more frequently on the basis of potential health benefits, because moderate alcohol intake also is associated with increased risk of breast cancer, violence, drowning and injuries from falls and motor vehicle crashes.”

Why don’t we know the limits?

Babor said one of the largest obstacles to better awareness is popular media, where people are often seen exceeding the limits of moderate drinking, although it is not portrayed as such.

In the new study, the Swedish researchers expressed disappointment in the lack of effect the health system had in reducing drinking. A separate study published last month documented that fewer than 15 percent of Swedes are asked about alcohol consumption at doctors’ visits.

Babor expressed optimism that physician involvement could help reduce excessive drinking in the U.S. and raise awareness of safe levels, as studies have shown that it can help reduce drinking.

But he also encouraged adopting strategies from elsewhere.

“In countries like the United Kingdom, there have been mass media campaigns to get people to recognize what the safe limits are,” he said. “In some cases, the limits are posted in bars, in menus. It’s possible to disseminate this information.”

He also said this information should be placed in ads. When alcohol companies urge people to drink responsibly, Babor said, “there’s no reason they can’t give what safe limits are.”

Joseph Brownstein
My Health News Daily

With age, the body finds it harder to cope with alcohol

Medical experts have called for new approaches to tackle substance abuse in older adults, several newspapers have reported. According to the Royal College of Psychiatrists, many middle-aged and elderly adults have problems with alcohol, illegal drugs and prescription medication, as well as complex mental health needs that may make the problems worse.

Most newspapers focussed on the report’s proposal to reduce the recommended safe alcohol limit for people over 65. The report recommended cutting it to a maximum of 1.5 units of alcohol a day, equivalent to half a pint of strong beer (5% strength) or a 125ml glass of wine (12% strength). In part, this is due to physical changes as the body ages that make alcohol harder deal with. The current recommended alcohol limits are a maximum of four units a day for men and three units for women.

The report, which has been drawn up by specialists in addiction and substance misuse, says that the misuse of drugs and alcohol by older people is a growing public health problem, which urgently needs to be addressed using measures that focus on the needs of this age group.

Where did the report come from?

The report was published by the Royal College of Psychiatrists. It was produced by a working group composed of specialists in substance addiction and misuse. The report aimed to set out guidance, principles and specific recommendations which, in the view of the College, should be adopted by its members.

What did it find?

The report says that the proportion of older people in the population is increasing rapidly and is projected to rise by 50% between 2001 and 2031. The number of older people with substance misuse problems is also reported to be increasing. The report points out that both alcohol and illicit drugs are among the top ten risk factors for premature death and health problems, and that mortality rates linked to drug and alcohol use are higher in older than younger people.

The report also says that substance use disorders in older people are frequently accompanied by complex psychiatric problems, and many older people show complex patterns and combinations of substance misuse, such as problem alcohol use and inappropriate use of prescription drugs.

What sort of substances do older people abuse?

The report covers legal medication, tobacco, alcohol and illegal drugs, as well as illicit “street” use of prescription and over-the-counter drugs.

Regarding use of prescription and over-the-counter medication, the report says that rates of misuse are high, particularly in older women. Although alcohol use declines with age, a significant number of older people consume alcohol at dangerous levels. While illicit drug use is currently uncommon in over-65s, the report projected that this would increase as people who are over 40, who use illicit drugs in significantly increasing numbers, get older.

It also says there is growing evidence that older people may be using a combination of legal and illegal drugs, as well as prescribed and over-the-counter medications. This practice, known as polypharmacy or polydrug dependence, is a particular problem in older people with physical and mental health problems. For example, patients may be offered, borrow or share out-of-date medications, take foods or drugs that interact or forget what drugs they have taken.

The report also says that older men are at greater risk of developing alcohol and illicit substance misuse than women, but older women have a higher risk of developing problems related to the misuse of prescribed and over-the-counter medications.

What are the risk factors for developing substance misuse in older people?

The report says that physical health problems and the long-term prescription of medications, such as hypnotics, anti-anxiety drugs and painkillers, are important factors in the development of substance misuse.

Psychosocial factors such as bereavement, retirement, boredom, loneliness, homelessness and depression are all associated with higher rates of alcohol use. It is possible that poorer cognitive function and mental health problems, such as anxiety and depression, contribute to substance misuse. However, the relationship is complex and it is unclear whether mental health problems lead to substance abuse or the other way around.

How big is the problem of substance abuse among older people?

The report does not give a figure for the overall proportion of older people with substance misuse problems. However, it says that estimates from Europe suggest the number of people over 65 with a problem will more than double between 2001 and 2020.

Below are some more figures from the report:

Between 1992 and 2008, the highest alcohol-related death rates were in men and women aged 55-74.
In 2008, over one-fifth of older men reported drinking more than four units of alcohol on at least one day of the week, while 10% of older women reported drinking more than the recommended maximum of three units.
During 2008-2009, 4.8% of over-45s in the UK reported use of an illicit drug in the previous year. The most significant problem for the over-40s was heroin use, either alone or in combination with crack cocaine.
Although smoking rates are lowest in people over 60, 13% of men and 12% of women in this age group smoke.

Why does the college say that older people should drink less?

The report says that because of physiological changes associated with ageing, older people are at increased risk of experiencing adverse physical effects from substance misuse, which includes drinking relatively modest amounts of alcohol. Alcohol, together with tobacco use, has the greatest impact on physical health for older adults, causing cardiovascular, gastrointestinal, neurological and respiratory problems.

The report also points out that older people tend to have higher blood levels of alcohol than younger people who drink the same amount. The difference can be attributed to a lower body-mass-to-water ratio and a less efficient metabolism. There is also ample evidence that the threshold at which alcohol causes harm is lower in older drinkers than in younger people.

In older people, heavy prolonged alcohol misuse may increase the risk of developing vascular dementia or Alzheimer’s disease, may have other indirect effects on brain cells, and may have a direct toxic effect, producing “alcoholic dementia”.

As people age, their ratio of body water to fat falls and their liver becomes less efficient, which can increase the effects of alcohol and other substances. The responsiveness of the brain also alters, so that alcohol produces a more rapid depressant effect, resulting in impaired co-ordination and memory, for example.

What are the current recommended drinking limits?

The current recommended drinking limits are a maximum of four units a day for men and three units for women. One unit of alcohol is 8g or 10ml of pure alcohol. This is the equivalent of a third of a pint of 5%-strength beer, half a standard (175ml) glass of 12% red wine, or a 25ml single measure of 40% spirits.

What does the college want to happen now?

The report says that the currently recommended safe limits for alcohol are based on younger adults and are too high for older people. Recent evidence suggests that the safe upper limit for older people is 1.5 units a day, or 11 units a week.

The authors also say that binge drinking in older people should be defined as more than 4.5 units in a single session for men and more than 3 units for women.

Overall, the report says that older adults need to be given more attention as they are currently “invisible” in terms of service provision, clinical guidelines, research, healthcare policy and the training of health professionals. For example, it says GPs should screen all people over 65 for substance misuse as part of a routine health check, while more research is needed into treatment and management of substance misuse in this age group. It also points out that treatment of both coexisting physical and psychological conditions is an important part of management. Training health professionals about the impact of substance misuse in older people “is not an optional extra”, it argues.

NHS Choices

The European Union is the heaviest alcohol drinking region in the world. Therefore, in Europe we suffer from the highest alcohol related problems. It is estimated that 58 million adults in the EU drink at risky levels, and 23 million are alcohol addicted.

Alcohol constitutes the primary risk factor for accidents, injuries and violence. Approximately half of the deaths attributable to alcohol are from injuries.

This alcohol issue is being addressed at the 3rd European injury prevention conference, organised by EuroSafe in cooperation with the Hungarian Presidency of the European Council. Today stakeholders in the prevention of accidents and injuries from Europe and other continents meet in Budapest to exchange, debate and discuss the latest results in injury research, policies and practices.

As the “Recommendations of the European Council on the prevention of injury and the promotion of safety” from 2007 highlight; every year, about 235 000 citizens of the Community die as a result of an accident or violence. In children, adolescents and young adults accidents and injuries are the leading cause of death, with alcohol playing a major role.

Over one fifth of the European population aged 15 years and older report heavy episodic drinking; 16% of cases of child abuse involve alcohol; 350 000 youngsters age 15 to 16 report fights involving alcohol. Alcohol abuse can be attributable to 4 out of 10 homicides in the EU and 1 in every 6 suicides involves alcohol. The list can be extended and thus injuries represent a huge financial burden on health and welfare systems, causing about 20% of sick leave and constituting a major factor for reduced productivity.

Andrea Lavesson, President of Active – sobriety, friendship and peace points out that “safety is a real welfare issue and injury prevention thus is a question with decisive influence on young European’s quality of life. That’s why we need and demand leadership to take the 2007 European Council Recommendations by their wording: better alcohol control policies reduce alcohol harm and in doing so improve injury prevention and make Europe safer and financially sustainable.”

Mariann Skar, European Alcohol Policy Alliance Secretary General, emphasized: ‘in the times of economic hardship we cannot afford to waste money in public health budgets on admissions that could be easily avoided. This can be achieved by better control and enforcement of drink driving regulations (BAC levels) and age restrictions as well as neither promoting nor selling alcohol at mass sports and music events which target audience is primarily young people.’

European Alcohol Policy Alliance

The association between poor hand hygiene of health care workers and nosocomial infection is well established. The National Hand Hygiene Initiative has been established to improve hand hygiene among health care workers, and the use of ethanol- or isopropanol-based hand sanitisers has been widely adopted in the hospital setting. To encourage their use by health care workers, many hospitals have undertaken extensive education programs and made hand sanitisers with high alcohol content readily available at all points of patient care. An unanticipated but potentially adverse outcome of this campaign is the intentional consumption of hand sanitisers by patients.

We report the case of a 45-year-old man, with a history of polysubstance misuse, who was admitted to our institution with epigastric pain in the setting of acute-on-chronic alcohol intake. No evidence of pancreatic or biliary disease was found and the diagnosis of probable alcohol-related gastritis was made. On Day 3 of admission, the patient became increasingly drowsy. Clinical examination showed that he was rousable, and had a Glasgow Coma Scale score of 13. There were no other significant findings. Some hours later, six near-empty 375 mL bottles of Aqium Gel (Ego Pharmaceuticals, Melbourne, Vic), an antibacterial hand sanitiser that has an ethanol content of 66%, were found by the patient’s bedside. Excipients in this gel include thickener, dexpanthenol, dl-alpha-tocopheryl acetate, fragrance, pH neutraliser and water.3 On direct questioning, the patient admitted to intentionally consuming the contents of the hand sanitiser bottles. This was supported by a breath test performed about 40 minutes after the bottles were found, which showed a blood alcohol concentration of 0.271%. Following advice from the Poisons Information Line, supportive therapy was instigated and the patient made an uneventful recovery.

Intentional consumption of ethanol- and isopropanol-based hand sanitisers by hospitalised patients has been described in overseas settings and serious adverse outcomes (including the need for intubation) have occurred.4-6 In one emergency department, all removable bottles of alcohol-based hand sanitiser in patient care areas were replaced with non-removable, self-contained dispensers.6 Experience at our institution over the past 6 months suggests that consumption of alcohol-based hand sanitisers by inpatients may be an increasing problem in Australian settings — we are aware of a further three patients who have consumed these products while at our institution.

An increased awareness of this practice is required among health care workers in Australia, as it has the potential to create diagnostic dilemmas and lead to serious outcomes, and preventive measures need to be identified and implemented.

The Medical Journal of Australia
Lachlan M Batty, Intern
Anna J Brischetto, Medical Registrar
Ajay C Kevat, Intern
Michael J Oldmeadow, Director of Physician Training
The Alfred, Melbourne, VIC.