Yarning about substance misuse
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Donna Lei Rioli
Donna is a young Nyungar woman who is dedicated to the heritage and culture of the Nyungar people on her mother's side, Robyn Collard, and the Tiwi people on her father's side, Maurice Rioli. Whadjuk/Balardong is her mother's country and her father and grandfather's country is at Wulawunga on Melville Island north of Darwin.
Reviews
Materials relating to the use of alcohol have previously been collected and reviewed to develop the background information that is archived below. An updated review is currently being developed.
Background information
Note: updated background info is currently being developed. This archived material is provided for those who are interested in aspects of alcohol use including health risks and the historical background of alcohol misuse in Australia.
Introduction
The term 'alcohol' describes a series of organic chemical compounds, but only one type, ethyl alcohol or ethanol, is found in drinks intended for human consumption. Alcohol is produced by fermentation - the action of yeast on liquids containing sugars and starches. Alcohol, when swallowed, is rapidly absorbed into the bloodstream, and its effects on many organs and systems within the body, are evident within minutes [1]. While alcohol works at the cellular and systemic level in the human body, its most immediate and readily apparent effects are on the brain. Alcohol is a psychoactive (mind-altering) drug, and is one of the most widely used drugs in the world [2]. Classified as a depressant drug, alcohol slows down activity in the central nervous system, affecting concentration and coordination, and slowing down the response time to unexpected situations [3]. In its pure form alcohol is a clear, colourless liquid with a pungent odour and burning taste [4]. Alcoholic drinks vary in colour and taste because of other ingredients that are added to them.
Alcohol is widely used and enjoyed throughout our society. Several decades of evidence have confirmed that, at relatively low levels, alcohol has some health benefits from middle age onwards [1]. While most drinkers consume alcohol in moderate quantities, some people drink heavily, inappropriately and with adverse and sometimes tragic results. 'Alcohol-related' problems constitute a major cause of concern, at local, national and international levels [5]. Excessive levels of alcohol consumption can produce both short-term and long-term health effects. People who drink regularly, place themselves at an increased risk of chronic ill health and premature death. These patterns of drinking not only have potential health consequences, they also have substantial social and economic implications, which can affect the individual, their families and workplaces, and society as a whole [1].
Effects of alcohol misuse
Alcohol misuse has health, social and economic costs and benefits, for both individuals and populations. At high levels of consumption, the harms far outweigh benefits, as higher consumption results in greater costs to one's health and social wellbeing [1]. Excessive alcohol consumption is associated with a variety of adverse health consequences, including liver cirrhosis, mental illness, several types of cancer, pancreatitis, and fetal growth retardation. Adverse social effects related to alcohol misuse include aggressive behaviour, domestic violence, family disruption, and reduced productivity [6]. In Australia, alcohol is second only to tobacco as the major cause of drug-related mortality [7]. Alcohol misuse is a problem that could affect any member of society, including the majority who are abstinent or use alcohol in moderation [8].
The effects of any drug (including alcohol) vary from person to person. Various factors determine the effect that alcohol has on the body. These factors include the type and amount of alcohol consumed, the environment, the user's characteristics such as gender, body size, age, food intake, ethnicity, general health and fitness, as well as expectation of the drug experience [9].
Short-term health effects
The short-term physical effects associated with the consumption of one to three standard drinks per hour may include a change in heart rate, a reduction in body temperature, dilation of the small blood vessels producing a warm flushing, stimulation of appetite, increased urination and reduced muscle coordination [9]. Alcohol slows down the messages sent between the brain and the rest of the body. This can make a person feel relaxed and more confident, but may also reduce concentration and slow the reflexes. The initial effects of alcohol may reduce tension or inhibitions. With more alcohol, the effects extend to motor and sensory centres in the brain, causing a person to react more slowly to stimuli. For example, when driving, it is likely to take longer for a person who has been drinking to apply the brakes if the car ahead stops suddenly [1].
With increasing alcohol concentrations in the body, movement and coordination rapidly become more difficult. Confusion, blurred vision and poor muscle control are among some of the immediate effects of alcohol consumption. Excessive alcohol consumption over a short period of time often results in a hangover the next day. Commonly referred to as, 'binge drinking', this form of excessive drinking involves drinking heavily over a short period of time, or drinking continuously over a number of days or weeks. Binge drinking is harmful because it results in immediate and severe intoxication [3]. The hangover usually occurs several hours after drinking has stopped and the alcohol has been removed from the body. Symptoms include headaches, dehydration, tremors, dizziness, nausea and vomiting [9].
Long-term health effects
Alcohol misuse over the longer term is an important cause of ill health in our society. Increased levels and patterns of drinking enhance the risk of developing a number of disorders. Alcohol misuse over a long period of time can cause damage to many parts of the body. Impairment of brain and liver functions can be permanent. If the person's diet is also poor, this can further affect their health [3]. Prolonged, regular alcohol misuse increases the risk of developing health problems such as brain damage, disorders of the heart, hypertension, anaemia, loss of appetite, vitamin deficiencies, pancreatitis, liver damage (cirrhosis), gallstones and gastric haemorrhages [9]. The effects of alcohol misuse are often compounded and exacerbated by other risk factors, such as smoking, dietary factors, or other drugs [1]. Some of the long-term health consequences associated with alcohol misuse are described below:
Cirrhosis of the liver: The most common cause of illness and death associated with chronic alcohol misuse..
Cancer: Chronic heavy drinking has been shown to cause cancers of the mouth, throat and oesophagus. Smoking in conjunction with heavy drinking hugely increases the risk.
Cardiovascular disease: Alcohol misuse is associated with cardiomyopathy and is a causal factor in high blood pressure, haemorrhagic stroke and heart failure.
Cognitive problems and dementia: High levels of alcohol misuse affect the brain and continued levels of chronic drinking over time can lead to cell damage and cell death. This affects cognitive skills, memory, and reasoning skills.
Alcohol dependence: Once a person has become dependent on alcohol it is much more likely that drinking will continue in a manner that could harm both the drinker and others.
Social consequences associated with alcohol misuse
In addition to the health problems associated with alcohol misuse, certain patterns of drinking have social consequences that affect many members of the community. These range from minor acts of vandalism or offensive behaviour to far more serious antisocial behaviour, which can result in violence or injury to others [1]. Alcohol misuse has been shown to be a major contributor to injury through interpersonal violence, particularly assaults, domestic violence, and child abuse. It is also a contributing factor in some cases of suicide [6]. Financial problems, legal problems, work problems, sexual problems, accidents and poor personal appearance, are amongst the wide array of social problems associated with alcohol misuse.
Alcohol misuse in Australia
Alcohol is the most widely used psychoactive drug (mood-changing recreational drug) in Australia. People drink to relax, have fun and celebrate. In Australia, alcohol is part of most social occasions [3]. From the early colonisation of Australia to the late 19th century, spirits were the most widely consumed alcoholic beverages in this country. Throughout the 1900's, fluctuations in alcohol consumption were evident. Over the past century Australia has been depicted as a predominately male, beer drinking culture. Advances in refrigeration and brewing have resulted in the development of large scale commercial brewing of beer, and a shift away from the consumption of spirits [6]. While Australia remains a beer drinking country, wine consumption has increased more than threefold since the late 1940's, and there has been a general trend in the brewing industry towards beverages which are perceived to be 'lighter' in terms of colour, calorific content, and alcohol content [1].
In 1998, Australia was ranked 19th in the world in terms of per capita consumption of pure alcohol (7.6 litres per person) [10]. In that same year, the consumption of alcohol was a contributing factor in the deaths of 3 271 Australians between the ages of 0 and 64 [10]. The statistics for 1999 were very similar, Australia was ranked 21st in the world in terms of per capita consumption of pure alcohol (7.5 litres per person) [11].
Alcohol is second only to tobacco as the major cause of drug-related mortality in Australia [7]. From an analysis of 1998 National Drug Strategy Household Survey data, the National Alcohol Indicators Project estimated that 5.7% of current drinkers consume alcohol at medium risk levels for chronic harm and 3.1% of current drinkers consume alcohol at high risk levels for chronic harm [1]. The National Alcohol Indicators Project also estimated that 46% of current male drinkers and 32.5% of current female drinkers had consumed alcohol at levels considered high risk for acute harm at least once a month in the past year, with the highest proportion evident amongst 18 to 24 year olds [12].
The last decade has seen an important shift in the public health perspective of drinking, moving from an exclusive focus on the amount consumed to incorporating patterns of consumption. Community attitudes have also changed, as the Australian society is more likely to be aware of irresponsible patterns of drinking. In particular, there is an increased expectation that people who intend to drive should not drink.
Drinking guidelines
The National Health and Medical Research Council has recently launched new Australian Alcohol Guidelines to assist in reducing alcohol-caused deaths and related harm [1]. These guidelines advise that male drinkers should drink no more than an average of 40g of alcohol per day and females no more than an average of 20g of alcohol per day, to prevent chronic health problems. Furthermore it is recommended that, provided there are no other situational or individual risk factors (such as driving or pregnancy), men should drink no more than 60g on any day and woman no more than 40g per day to prevent acute conditions associated with bouts of intoxication, such as alcohol-related injuries [13].
Summary of guidelines for low risk drinking [14]
For risk of harm in the short- term:
|
Low risk |
Risky |
High risk |
|
|
Males |
up to 6 on any one day, |
7-10 on any one day |
11 or more on any one day |
|
Females |
up to 4 on any one day, |
5-6 on any one day |
7 or more on any one day |
For risk of harm in the long-term:
|
Low risk |
Risky |
High risk |
|
|
Males |
up to 4 |
5 to 6 |
7 or more |
Overall weekly level |
up to 28 |
29 to 42 |
43 or more |
|
Females |
up to 2 |
3 to 4 |
5 or more |
Overall weekly level |
up to 14 |
15 to 28 |
29 or more |
Source: table derived from World Health Organization (2000) International guide for monitoring alcohol consumption and related harm. Geneva: Department of Mental Health and Substance Dependence, Noncommunicable Diseases and Mental Health Cluster, World Health Organization.
References
1 National Health and Medical Research Council (2001) Australian alcohol guidelines: health risks and benefits. Canberra: Commonwealth of Australia.
2 Alcohol Advisory Council of New Zealand & Ministry of Health (2001) National alcohol strategy 2000-2003. Wellington.
3 Drug Info Clearinghouse (2002) Alcohol & drug info. Retrieved 17th July 2002 from http://druginfo.adf.org.au/article.asp?id=2198.
4 Julien RM (1995) A primer of drug action. 7th ed. New York: WH Freeman and Company.
5 Plant M, Single., E & Stockwell., T (1997) Introduction: Harm Minimisation and Alcohol. In: Plant M, Single., E & Stockwell., T, ed. Alcohol: minimising the harm. London: Free Association Books.
6 Ministerial Council on Drug Strategy (2001) Alcohol in Australia: Issues and Strategies. Canberra: Commonwealth of Australia.
7 Higgin K, Cooper-Stanbury, M., & Williams, P. (2000) Statistics on drug use in Australia. Canberra: Australian Institute of Health and Welfare.
8 Tai Y, Saunders, JB & Celermajer, DS, (1998) Collateral damage from alcohol abuse: the enormous cost to Australia. Medical Journal of Australia;168:6-7.
9 Health Department of Western Australia (1999) The effects of alcohol on the body: alcohol fact sheets for health professionals. Perth: Health Department of Western Australia.
10 Miller M, Draper, G. (2001) Statistics on drug use in Australia 2000. Canberra: Australian Institute of Health and Welfare.
11 World Drink Trends (2000) International beverage consumption and production trends. Oxfordshire: NTC Publications.
12 Heale P, Stockwell, T, Dietze, P, Chikritzhs, T. & Cataolon, P, (2000) Patterns of alcohol consumption in Australia, 1998.: National Alcohol Indicators Bulletin No. 3.
13 Stockwell T, Heale, P, Chikritzhs, T, Dietze, P & Catalano, P. (2002) How much alcohol is drunk in Australia in excess of the new Australian alcohol guidelines? Medical Journal of Australia;176:91-92.
14 World Health Organization (2000) International guide for monitoring alcohol consumption and related harm. Geneva: Department of Mental Health and Substance Dependence, Noncommunicable Diseases and Mental Health Cluster, World Health Organization.
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