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Alcohol Our Favourite Drug: The big picture: can nurses and midwives make a difference?. Prof. Jim Rankin Ist International Alcohol, Tobacco and Other Drugs Nursing & Midwifery Conference Adelaide, April 16, 2003. Advances in Knowledge and Understanding: Alcohol - Before 1960.

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alcohol our favourite drug the big picture can nurses and midwives make a difference

Alcohol Our Favourite Drug:The big picture: can nurses and midwives make a difference?

Prof. Jim Rankin

Ist International Alcohol, Tobacco and Other Drugs Nursing & Midwifery Conference

Adelaide, April 16, 2003

advances in knowledge and understanding alcohol before 1960
Advances in Knowledge and Understanding: Alcohol - Before 1960
  • Alcoholism a moral problem or a manifestation of mental illness
  • Alcoholism a disease - Alcoholics Anonymous
the scene 1964 treatment services
The Scene 1964: Treatment Services
  • Completely inadequate
  • Psychiatric hospitals
  • Residential
  • Custodial care
  • Inmates:
    • Inebriates’ Act
    • Psychiatric complications
    • Temporary accommodation & support
advances in knowledge and understanding of alcohol problems
Advances in knowledge and understanding of alcohol problems
  • A spectrum of drinking behaviours that may cause problems
  • A spectrum of alcohol-related problems
  • A spectrum of responses involving health promotion, prevention and intervention/treatment
broadening the base of treatment
Broadening the base of treatment:
  • Establishment of services in general hospitals
  • Shift of resources from psychiatric hospitals to community-based services
  • Shift of resources to provide a balance of residential and non-residential services
  • Initiatives to increase the involvement of general practitioners
responding to alcohol problems in australia potential resources
Responding to alcohol problems in Australia: potential resources
  • Medical practitioners 70,000 (est)
  • Addiction medicine specialists
    • Certified 140
    • Certification pending 60
  • Registered nurses 250,000 (est)
    • Registered midwives 67,000 (est)
  • Members of DANA 200+
  • Number of D & A services 2000 (est)
a whole of profession responsibility
A whole of profession responsibility

Practitioners

  • Clinical nurses
  • Nurse educators/academics
  • Nurse managers
  • Nurse researchers

Organisations

  • Registration bodies
  • General professional organisations
  • Academic organisations
  • Alcohol and drug
a vision of nursing and midwifery
A Vision of Nursing and Midwifery

Professions that play active roles in the development and implementation of comprehensive alcohol policies and programs for prevention and treatment

a vision of nursing and midwifery prevention and health promotion
A Vision of Nursing and Midwifery: Prevention and Health Promotion

Professions whose members incorporate into their professional activities strategies and practices that have as their objectives maintenance of abstinence and safe patterns of alcohol use, and reductions in hazardous and harmful use.

a vision of nursing and midwifery clinical care
A Vision of Nursing and Midwifery:Clinical Care

Professions whose members play a complementary role to these preventive strategies by

  • identifying and intervening with their patients whose are at risk because of their alcohol use; and
  • Identifying and responding to the health needs of their patients who already have alcohol-related damage
topics
Topics
  • Drinking patterns in Australia and their consequences
  • Effects of alcohol on health
  • Prevention, intervention and treatment
  • Potential roles of nursing and midwifery
  • Systems’ impediments to progress
drinking patterns in australia
Drinking Patterns in Australia

Population aged 14+ years %

  • Drinkers 811
  • Hazardous/harmful drinkers 351
  • Hazardous/harmful drinkers 142

Population aged 14-19 years

  • Drinkers 641
  • Hazardous/harmful drinkers 671

Aboriginal & Torres Strait Islander Peoples

  • Drinkers 621
  • Hazardous/harmful drinkers 821

1 = Last 12 months

2 = Last week

alcohol attributable deaths and hospital bed days 1998 9
Deaths

Caused 4,286

Prevented (7029)1

Total (2,744)

Note 1. 94% aged 60+ years

Hospital beddays

Caused 394,417

Prevented2 (255,433)

Total 138,974

Note 2. 79.7% aged 60+ years

Alcohol-attributable deaths and hospital bed days, 1998-9
potential benefits of policies designed to prevent alcohol misuse
Potential benefits of policies designed to prevent alcohol misuse

Preventable deaths 4,286

Preventable hospital beddays 394,417

social costs of drug abuse 1998 9
Social costs of drug abuse, 1998-9

$m %

Alcohol 7,560.31 22.0

Tobacco 21,063.0 61.2

Illicit drugs 6,075.8 17.6

Total 34,439.8 100.0

Avoidable costs of alcohol misuse $3,928.6m (62.1%)

Note 1. Costs of alcohol misuse 1.98% of GDP

slide21

Factors in Acute Alcohol-related Damage

Acutealcohol consumption

  • CNS depression:
  • Impairment of
  • Motor function
  • Coordination
  • Judgment
  • Respiration
  • Consciousness
slide22

Factors in Acute Alcohol-related Damage

Acutealcohol consumption

  • CNS depression:
  • Impairment of
  • Motor function
  • Coordination
  • Judgment
  • Respiration
  • Consciousness

Motor vehicles

Workplace

Hotels & bars

Other social venues

Sporting activities

Associated drug use

Drinking Circumstances and Environment

slide23

Factors in Acute Alcohol-related Damage

Trauma

Acutealcohol consumption

  • CNS depression:
  • Impairment of
  • Motor function
  • Coordination
  • Judgment
  • Respiration
  • Consciousness

Motor vehicles

Workplace

Hotels & bars

Other social venues

Sporting activities

Associated drug use

Drinking Circumstances and Environment

General Environment

trauma
Trauma
  • Fall injuries
  • Road injuries
  • Occupational and machine injuries
  • Fire injuries
  • Drowning
  • Assaults
  • Suicide
slide25

Factors in Acute Alcohol-related Damage

Acutealcohol consumption

  • CNS depression:
  • Impairment of
  • Motor function
  • Coordination
  • Judgment
  • Respiration
  • Consciousness

Overdose/poisoning

Motor vehicles

Workplace

Hotels & bars

Other social venues

Sporting activities

Associated drug use

Drinking Circumstances and Environment

General Environment

overdose poisoning
Overdose/Poisoning
  • Acute ethanol overdose and poisoning
  • Aspiration
  • Combined alcohol and drug overdose and poisoning
  • Methanol poisoning
slide27

Factors in Acute Alcohol-related Damage

Acutealcohol consumption

  • CNS depression:
  • Impairment of
  • Motor function
  • Coordination
  • Judgment
  • Respiration
  • Consciousness

Obstructivesleep apnoea

Motor vehicles

Workplace

Hotels & bars

Other social venues

Sporting activities

Associated drug use

Drinking Circumstances and Environment

slide28

Factors in Acute Alcohol-related Damage

Acutealcohol consumption

  • CNS depression:
  • Impairment of
  • Motor function
  • Coordination
  • Judgment
  • Respiration
  • Consciousness

Pregnancy

Sexual assaultChild Abuse

Motor vehicles

Workplace

Hotels & bars

Other social venues

Sporting activities

Associated drug use

Drinking Circumstances and Environment

slide29

Factors in Acute Alcohol-related Damage

Supportive HOME ENVIRONMENT Non-supportive

Privileged SOCIAL CLASS Under-privileged

Affluence INCOME Poverty

Very good COMMUNITY SERVICES Absent

Very good HEALTH SERVICES Absent

General Environment

slide30

Factors in Acute Alcohol-related Damage

Trauma

Acutealcohol consumption

  • CNS depression:
  • Impairment of
  • Motor function
  • Coordination
  • Judgment
  • Respiration
  • Consciousness

Overdose/poisoning

Obstructivesleep apnoea

Pregnancy

Sexual assaultChild Abuse

Motor vehicles

Workplace

Hotels & bars

Other social venues

Sporting activities

Associated drug use

Drinking Circumstances and Environment

General Environment

slide31

Effects of Long-term Alcohol Consumption

Long-termalcohol consumption

slide33

Effects of Long-term Alcohol Consumption

Long-term

alcohol consumption

Alcohol a necessary cause of diseases

alcohol a necessary cause of disease
Alcohol a Necessary Cause of Disease

Behavioural and Neurological

  • Alcohol dependence
  • Acute alcohol withdrawal
  • Delirium tremens
  • Acute alcoholic hallucinosis
  • Alcoholic polyneuropathy
  • Alcoholic cerebellar atrophy
  • Neuro-psychological impairment
  • Wernicke-Korsakoff syndrome
alcohol a necessary cause of disease1
Other diseases:

Alcoholic gastritis

Alcoholic hepatitis

Alcoholic cirrhosis

Alcoholic cardiomyopathy

Foetal alcohol effects

Foetal alcohol syndrome

Alcohol a Necessary Cause of Disease
slide36

Effects of Long-term Alcohol Consumption

Long-termalcohol consumption

Alcohol a contributing cause of disease

alcohol a contributing cause of disease
Alcohol a Contributing Cause of Disease

Cancer

  • Oropharyngeal
  • Oesophageal
  • Laryngeal
  • Liver
  • Female breast
alcohol a contributing cause of disease1
Alcohol a Contributing Cause of Disease

Gastro-intestinal and hepatic

  • Oesophageal varices
  • Gastro-oesophageal haemorrhage
  • Unspecified cirrhosis
  • Haemochromatosis
  • Acute pancreatitis
  • chronic pancreatitis
alcohol a contributing cause of disease2
Alcohol a Contributing Cause of Disease

Other diseases:

  • Epilepsy
  • Hypertension (males)
  • Ischaemic stroke (males)
  • Haemorrhagic stroke (males)
  • Psoriasis
  • Depression, attempted suicide and suicide
  • Spontaneous abortion
slide40

Effects of Long-term Alcohol Consumption

Long-termalcohol consumption

Alcohol a contributory factor to disease outcome

alcohol a contributory factor to disease outcome
Alcohol a Contributory Factor to Disease Outcome
  • Hepatitis C
  • Pulmonary infection
  • Post-operative complications
slide42

Effects of Long-term Alcohol Consumption

Long-termalcohol consumption

Alcohol a protector

from diseases

alcohol a protector from disease
Alcohol a Protector from Disease
  • Ischaemic heart disease
  • Hypertension (females)
  • Supra-ventricular cardiac dysrhythmias
  • Hear failure
  • Ischaemic stroke (females)
  • Haemorrhagic stroke (females)
  • Cholelithiasis
slide44

Effects of Long-term Alcohol Consumption

Long-termalcohol consumption

Alcohol a necessary cause of diseases

Alcohol a contributory cause of diseases

Alcohol a contributory factor to disease outcome

Alcohol a protector

from diseases

General Environment

prevention treatment of alcohol related problems a spectrum of problems and responses

Prevention & Treatment of Alcohol-related Problems:A Spectrum of Problems and Responses

The goal: Harm minimization

advances in disease prevention health promotion
Advances in disease prevention & health promotion
  • Drinking Guidelines
  • Low alcohol content beers
  • Labelling of alcoholic beverage containers with the number of drinks
  • Drink-driving counter measures

▬ Random breath testing

▬ Zero blood alcohol levels for probationary drivers

advances in disease prevention health promotion1
Advances in disease prevention & health promotion
  • Thiamine supplementation of flour
  • Indexation of alcohol taxes
  • Initiatives to reduce alcohol-related harm in and near licensed premises
advances in clinical management
Advances in clinical management
  • Screening instruments (AUDIT)
  • Assessment instruments
  • Effective behavioural interventions
      • Motivational interviewing
      • Cognitive behavioural restructuring
      • Brief interventions
  • Pharmacotherapies:
      • Naltrexone
      • Acamprosate
  • Management of alcohol-related physical diseases
changes in alcohol problems
Changes in alcohol problems
  • Between 1988 and 1998 per capita consumption as fallen from 9.4 to 7.5 litres
  • Australia has fallen from 12th to 19th place internationally in per capita consumption
  • These declines associated with falls in:
    • Incidence of alcohol-related road injury and deaths
    • Total alcohol-caused mortality
    • Deaths where alcohol is the sole cause
    • Deaths where alcohol is a contributing cause
slide50

Prevention and Treatment of Alcohol-related Problems:A Spectrum of Problems and Responses

Alcohol Use

Safe

Primary prevention

Nil

slide51

Prevention and Treatment of Alcohol-related Problems:A Spectrum of Problems and Responses

Case finding &early intervention

Hazardous

Alcohol Use

slide52

Prevention and Treatment of Alcohol-related Problems:A Spectrum of Problems and Responses

Harmful

Treatment

Alcohol Use

slide53

Prevention and Treatment of Alcohol-related Problems:A Spectrum of Problems and Responses

Alcohol-relatedproblems

Alcohol Use

Primary prevention

slide54

Prevention and Treatment of Alcohol-related Problems:A Spectrum of Problems and Responses

Alcohol-relatedproblems

Case finding &early intervention

Alcohol Use

slide55

Prevention and Treatment of Alcohol-related Problems:A Spectrum of Problems and Responses

Alcohol-relatedproblems

Treatment

Alcohol Use

slide56

Prevention and Treatment of Alcohol-related Problems:A Spectrum of Problems and Responses

Alcohol-relatedproblems

Harmful

Treatment

Case finding &early intervention

Hazardous

Alcohol Use

Safe

Primary prevention

Nil

slide58

The Role of Nursing: Clinical Practice

General Nurses

Safe Drinking Practices

slide59

The Role of Nursing: Clinical Practice

General Nurses

Safe Drinking Practices

Drinking History

slide60

The Role of Nursing: Clinical Practice

General Nurses

Safe Drinking Practices

Drinking History

Screening (AUDIT)

slide61

The Role of Nursing: Clinical Practice

General Nurses

Safe Drinking Practices

Drinking History

Screening (AUDIT)

Brief intervention

slide62

The Role of Nursing: Clinical Practice

General Nurses

Safe Drinking Practices

Drinking History

Screening (AUDIT)

Brief intervention

Specialist referral

slide63

The Role of Nursing: Clinical Practice

General Nurses

Safe Drinking Practices

Drinking History

Screening (AUDIT)

Brief intervention

Specialist referral

Treatment of withdrawal

slide64

The Role of Nursing: Clinical Practice

SpecialtyNursing andClinical NurseSpecialists

Public health

Community health

Mental health

Emergency

Critical care

Gastroenterology

Hepatology

Neurology

Midwifery

Paediatrics

slide65

The Role of Nursing: Clinical Practice

SpecialtyNursing andClinical NurseSpecialists

Public health

Community health

Mental health

Emergency

Critical care

Gastroenterology

Hepatology

Neurology

Midwifery

Paediatrics

Consultation & support

slide66

The Role of Nursing: Clinical Practice

SpecialtyNursing andClinical NurseSpecialists

Public health

Community health

Mental health

Emergency

Critical care

Gastroenterology

Hepatology

Neurology

Midwifery

Paediatrics

Consultation & support

Specialistassessment

slide67

The Role of Nursing: Clinical Practice

SpecialtyNursing andClinical NurseSpecialists

Public health

Community health

Mental health

Emergency

Critical care

Gastroenterology

Hepatology

Neurology

Midwifery

Paediatrics

Consultation & support

Specialistassessment

Management ofspecialty problems

slide68

The Role of Nursing: Clinical Practice

SpecialtyNursing andClinical NurseSpecialists

Public health

Community health

Mental health

Emergency

Critical care

Gastroenterology

Hepatology

Neurology

Midwifery

Paediatrics

Consultation & support

Specialistassessment

Management ofmedical problems

Follow-up

slide69

The Role of Nursing: Clinical Practice

D and A Nursing and Clinical Nurse Specialists

General hospitalsPsychiatric hospitalsCommunity healthDetoxification unitsOther D & A services

slide70

The Role of Nursing: Clinical Practice

D and A Nursing and Clinical Nurse Specialists

General hospitalsPsychiatric hospitalsCommunity healthDetoxification unitsOther D & A services

Consultation & support

slide71

The Role of Nursing: Clinical Practice

D and A Nursing and Clinical Nurse Specialists

General hospitalsPsychiatric hospitalsCommunity healthDetoxification unitsOther D & A services

Consultation & support

Specialistassessment

slide72

The Role of Nursing: Clinical Practice

D and A Nursing and Clinical Nurse Specialists

General hospitalsPsychiatric hospitalsCommunity healthDetoxification unitsOther D & A services

Consultation & support

Specialistassessment

Management ofalcohol problems

slide73

The Role of Nursing: Clinical Practice

D and A Nursing and Clinical Nurse Specialists

General hospitalsPsychiatric hospitalsCommunity healthDetoxification unitsOther D & A services

Consultation & support

Specialistassessment

Management ofalcohol problems

Follow-up

slide74

The Role of Nursing: Clinical Practice

General Nurses

SpecialtyNursing andClinical NurseSpecialists

D and A Nursing and Clinical Nurse Specialists

Safe Drinking Practices

Drinking History

Consultation & support

Consultation & support

Screening (AUDIT)

Specialistassessment

Specialistassessment

Brief intervention

Management ofmedical problems

Management ofalcohol problems

Specialist referral

Follow-up

Treatment of withdrawal

Follow-up

progress in australia
Progress in Australia
  • Services in general hospitals 1964
  • Appointment of assistant directors of nursing (D and A) in NSW 1982
  • Establishment of clinical nurse specialists and consultants in some states
  • Establishment of DANA 1986
  • NSW Nursing Project
  • Academic appointments
  • Establishment of academic programs
  • Availability of educational resources
systems impediments to progress
Systems impediments to progress
  • Increasing and competing demands on nurses and nursing services
  • Deceasing availability of nurses
  • Silo organizational structures
  • Fragmentation of patient care
  • Shift of Federal government support away the concept of universal health care
  • Inadequate funding of public hospitals
  • Increasing numbers of for-profit private hospitals
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