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Alcohol and violence in a medical context

Alcohol and violence in a medical context

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Alcohol and violence in a medical context

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  1. Alcohol and violence in a medical context Åsa Wetterqvist, MD, SNIPH Stockholm 20121116

  2. Mama, just killed a man Put a gun against his headPulled my trigger, now he's deadMama, life had just begunBut now I've gone and thrown it all away…Mama, oh !Didn't mean to make you cry,If I'm not back again this time tomorrowCarry on, carry on, Nothing really matters…

  3. Youth and alcohol • Alcohol can make a culprit • Alcohol can make a victim • Both are victims to alcohol

  4. The teenagebrain • Strong motor butweaksteering and bad breaks • Immature frontal lobes – center ofdecisionmaking, emotion- and impulsecontrol, planning ahead, seeconsequences, logicalthinking and empathy • Use it or lose it – neurons adapttofewerbutmoreefficient – Rolemodels and new impressions important

  5. The teenagebrain • Evolution - Risktakingneededtoleavehome • Alcohol, peerpressure and the teenage, risktakingbrain – a dangerous combination • The adaptingteenagebrain is morevoulnerabletodirect harm by alcohol

  6. Alcohol and violence - Why? • Complexcombinedeffectofpsycological (eg less fear, missjudged signals), social (egexpectations from society , hostile and brutal environmentsetc ) and geneticalfactors ( somemorevulnerabletoalcohol).

  7. Alcohol • Has an effect on all cells and every organ in the body.

  8. Dopamine • The reward system of the brain. • The ” Old ” part of the brain • The survivalof the species and the individual • Role : Important lust/pleasure – driven behavioursarerepeated • Dopamine gives a feeling ofpleasure • Alcoholincreases the amountof dopamin

  9. ALCOHOL Per mille in the blood and changes in behavour 0,2-0,3 per milleEndorphinesincrease, feeling warm, relaxed. Less self- criticism, Reactiontimeincreases and precision decreases. 0,5-0,6 per milleExhilaration, Less inhibitions, Less discerning (bad judgement ) 0,8 per milleReflexesslowing, exaggerated movements, loud, impaired vision, overconfident, ”behavesdrunk” www.fhi.se/riskbruksprojektet

  10. ALCOHOL - Per mille in the blood and changes in behavour 1,0 per milleSlurredspeech,lossofmuscularcontrol, hard to walk properly, hard tocontrol emotions , visiblyverydrunk 1,5 per milleFalls, Vomits , emotional outbursts, falls asleep 2,0 per milleHard to talk and walk upright , double vision 3,0 per milleNo perception of the sourroundings, borderingtounconsciousness 4,0 per milleunconsciousness, slowbreading, risk of fatal alcoholpoisoning www.fhi.se/riskbruksprojektet

  11. Patterns ofdrinking and consequences ”Vodka belt””Continental” Social problemsLiver damage Accidents Cancer ViolenceGastrointestinal CerebrovascularSkeleton/ joints CardiacarrhythmiasNeuralsystem Depression/Suicide

  12. The Swedesnow drink bothways!

  13. Health professionals choose to close their eyes Does it happen that you don’t ask about alcohol habits even if you think that the patients symptoms are alcohol related? Yes - doctors 30 %- nurses 35 %

  14. Risk Drinking 0 - moderate consumption Numbers Risk • Abuse Dependence Growing problems No problems Evident problems A level of alcohol consumption, or pattern of drinking that is likely to cause harm if present drinking habits persist

  15. Health effects and numbers Elevated and risky levels No dependence Dependence Health effects No problems Problems

  16. Attityder till alkohol och tobak Sökord i Microsoft ClipArt äta middag, bröllop, champagneflaskor, helgdagar, högtider, jubileum, nyårsafton, par, smekmånad hälsovård, läkare, medicin, varningar

  17. Are you an alcoholic? Are you an alcoholic? Tell me about your alcohol consumption? Tell me about your alcohol consumption?

  18. All the other in the visit C-Reative Protein Bone density and osteoporosis Hormone replacement Erectile dysfunction Hypertension Physical activity Early ultrasound Domestic violence? Abuse? Pre-hypertensive? Cancer mammae Obesity Depression Anxiety Bipolar disorders Colo-Rectal cancer Blood lipids Alcohol BMI and Waist-Hip Ratio Fibrinogen Vision, glaucoma and hearing Smoking Pap-smear Diabetes Chronic obstructive lung disease MMI Dementia Alzheimer Homocystein Genetic tests? Cardiovascular risk profile Immunisations/ Influensa Pneumonia Stenosis of the Carotid arteries STD prevention Chlamydia Abdominal aorta aneurysm

  19. 35000 30 000 30000 25000 20000 15000 10000 1 800 1 900 5000 Alcohol- counseling Tobacco cessation averagemedicaltreatment Cost - benefit Cost ( in Euro ) topreventoneyearofillness or prematuredeath.

  20. Another Saturdaynight at the emergencyDepartment…

  21. YOUR MOTIVATION ?

  22. Dopamin • Hjärnans belöningssystem. • Mesokortikolimbiska dopaminsystemen • Utvecklingshistoriskt gammalt • Arten och individens överlevnad • Viktiga lustfyllda beteenden upprepas • Lustupplevelsen framkallas av dopamin • Alkohol ökar dopaminmängden

  23. THANK YOU !! KEEP UP THE GOOD WORK!!!