Mental health articles

This section identifies commonly misused substances and describes how they are used, their effects and complications. If staff in mental health services are to work effectively with people with a dual diagnosis it is essential that they have this knowledge which will underpin assessment, subsequent care planning and treatment interventions. Having an understanding of the language associated with substance misuse can also be important. Some drug users’ jargon is included, indicated by the word being presented in italics and inverted commas (for example, ‘gear’).  

Alcohol is legal, widely available and socially acceptable. Over 90 per cent of adults drink. Alcoholic drinks come in different strengths, indicated by the ‘alcohol by volume’ (ABV), the percentage of the total liquid that is alcohol. Alcohol consumption can be measured in units. One unit is the equivalent of half a pint of standard strength beer (3–4 per cent ABV), a pub measure of spirits (around 40 per cent ABV) or a small (125ml) glass of wine (8–10 per cent ABV). Recommended ‘safe’ drinking levels are 3–4 units daily for a man and 2–3 for a woman.

However, consistently drinking at the upper levels (i.e. 4 units daily for a man and 3 for a woman) is not advisable suggesting that some days each week should be alcohol free. The effects of alcohol will depend on how much the person is used to drinking. Tolerance develops (i.e. more is needed to gain the same effect). With small amounts of alcohol the person is likely to feel less inhibited and more sociable and relaxed. Their heart rate will increase and they may appear flushed (due to vasodilation). As consumption increases slurred speech and a lack of coordination may be evident. The drinker’s emotions may become labile. With heavy use the person may experience double vision, stagger, lose balance and lose consciousness. Severe intoxication may result in vomiting which can prevent fatal overdose. However, impaired consciousness can lead to death if the drinker inhales his or her vomit. With regular, heavy use some people become physically dependent and, in the absence of alcohol, experience withdrawal symptoms, typically in the morning, when the level of alcohol in their body has fallen. Sweatiness, shaking, nausea and vomiting are common symptoms. Delirium tremens, a state characterized by rapid pulse, raised blood pressure, feverishness, sweating, shaking, disorientation, agitation, hallucinations, and sometimes also paranoid delusions is experienced by some people. Seizures are another possible complication of alcohol withdrawals. These can occur from 7 to 48 hours after stopping drinking.

Both delirium tremens and withdrawal seizures can be fatal. While some people will drink heavily every day, others will drink in binges. The pattern of these varies, for example, some people will drink heavily for a number of weeks and then remain abstinent for several months, others drink heavily for 2- or 3-day periods and remain abstinent throughout the remainder of the week. Even this latter pattern can pose risks to the person’s physical health. A range of mental and physical health problems are associated with heavy alcohol use. Depression is common, but it can be difficult to assess whether the depression is independent of, or secondary to, alcohol use. If abstinence is achieved and the depression is secondary to drinking, symptoms should begin to improve after 2–3 weeks. A similar picture exists with anxiety and many drinkers experience problems with both depression and anxiety. Risk of suicide is particularly high in people with alcohol problems. The depressive symptoms associated with drinking are a trigger, and, when intoxicated, the person’s inhibitions are likely to be reduced, making them more likely to act on suicidal thoughts.

To add to these risks, a range of factors which can be typical of the lifestyles of people with drink problems are associated with suicidal thoughts: having major financial problems (spending money on alcohol can become the priority); difficulties with the police or courts (through alcohol-related convictions); problems with close friends or relatives (due to the impact of the person’s drinking on them and the tensions and arguments that may follow); and a lack of social support (as relationships break down).

Alcohol, used in combination with other drugs which are central nervous system (CNS) depressants, significantly increases the risk of intentional and accidental overdose. Alcoholic hallucinosis is a condition where auditory or visual hallucinations occur during or after a period of heavy drinking. Delusions, ideas of reference and an abnormal affect may also be present. Typically the symptoms abate after a few weeks. Other health problems associated with heavy drinking include: brain damage (which may be irreversible), gastritis, pancreatitis, ulcers, oesophageal varices, peripheral neuropathy, liver damage (for example, alcoholic hepatitis, cirrhosis), Wernicke’s encephalopathy and Korsakoff’s syndrome. ‘Black outs’, transient memory loss induced by intoxication, can be experienced by both dependent and non-dependent drinkers.

Some people have total memory loss for a period of time, which may last from a few hours to several days. Because alcohol affects judgement and coordination, drinkers may be particularly prone to accidents, potentially putting themselves and others at risk of harm. Driving, operating machinery and working at heights should be avoided. Older people may be especially susceptible to falling. Some of the social consequences of drinking have been highlighted above. Others include: school exclusion, lost employment, violence (within and outside the home), neglect of children, engaging in unsafe sex, drinking and driving, homelessness. Women who drink when they are pregnant risk complications and damage to their unborn child.

Tags: alcohol abuse, body, effects