GLASGOW COUNCIL on ALCOHOL Tackling the misuse of alcohol COCAINE AND ALCOHOL THE HIDDEN MIXER 9 TH OCTOBER 2006 Alex Meikle

GLASGOW COUNCIL on ALCOHOL Tackling the misuse of alcohol PREVALENCE LEVELS IN SCOTLAND: No of people in Scotland with problematic drug misuse levels in Scotland = 55,000 No of people in Scotland estimated to be alcohol dependent = 276,213 (Source: Alcohol Concern 2003)

GLASGOW COUNCIL on ALCOHOL Tackling the misuse of alcohol THE TIERS Tier 1 Services – General public, prevention, education and awareness Tier 2 Services - People experiencing moderate to severe alcohol problems e.g. local councils on alcohol Tier 3 Services - People with severe alcohol problems requiring specialist help e.g. CAT Community Rehab Tier 4 Services – People with acute alcohol problems requiring residential care or hospitalisation

GLASGOW COUNCIL ON ALCOHOL GCA is composed of five key components, which are: Prevention and education work The counselling services including the Alcohol Counselling Centre (ACC), Homelessness, Community Counselling and Young People’s counselling service Training (both internally and externally) Groupwork i.e. the ACE Programme East End Community Alcohol Support Service

WHAT GCA DOES THE MANTRA!!! ADDS VALUE TO ADDICTION SERVICES WITHIN GREATER GLASGOW BY: Keep people at Tier 2, prevent them from relapsing to Tiers 3 or 4 and eventually move them to Tier 1 Assess for, signpost and fast-track for people who need them into Tiers 3 and 4 services Provide throughcare service for people coming out of Tiers 3 and 4 services

GLASGOW COUNCIL ON ALCOHOL Cocaine use in Scotland is the third highest in Europe (UN report July 2006) 1.4% of year olds use this drug. Scottish Drugs Misuse Database (2006) reports 8% of all presentations to addiction services in Scotland are using cocaine compared to 5% in 2000/01 Alcohol use has remained steady at 13% in 2004/05 compared to 12% in 2000/01

ALCOHOL AND COCAINE One study in US estimates that 75% of cocaine users use alcohol both independently and while using cocaine Harm from using both is greater than using either separately Treatment outcomes are different for simultaneous use Therefore, extremely important to identify simultaneous use

ALCOHOL AND COCAINE Combined bio-chemical effects: Alcohol leads to 30% increase in blood levels of cocaine if taken at the same time or just before Liver combines cocaine and alcohol to produce Cocaethylene which increases dopamine release and can lead to sudden cardiac death

ALCOHOL AND COCAINE Combined psychiatric effects: More euphoric and rewarding leading to an increased high Decrease in alcohol sedation or cognitive impairment Increase in interpersonal and physical violence Increase in sexual risk behaviours Increase in impulsive decision making and decrease impact on memory and learning

ALCOHOL AND COCAINE Consequences: The bio-chemical effects and the psychiatric effects combine with potentially disastrous consequences More “Bangs for your bucks” Less apparent effects of alcohol “I can handle this better” Two substances which in themselves lead to volatility in individuals have this factor significantly enhanced More impulsive behaviour Greater chance of heart failure and sudden death Treatment is more complicated as there are contra- effects i.e. withdrawl can be accompanied by intoxication

ALCOHOL AND COCAINE Conventional Scottish Treatment Characteristics for Service Users Opiate/Injecting/Alcohol users Poor Unemployed Depressant users From “Deprived backgrounds” (Dep Cats 6-7) Strong association with physical and mental health issues as well as issues such as abuse Addiction as manifestation of deeper issues therefore treatment is necessarily holistic

ALCOHOL AND COCAINE Treatment Characteristics for alcohol and cocaine users Polydrug users with no one substance in ascendancy Educated/Aspirational/Affluent Employed Stimulant user and risk taker with alcohol exacerbating the stimulant Classless from all backgrounds (Dep Cats 1-7) No necessary casual connection to other issues Addiction as hedonism related to lifestyle, culture, availability, leisure clashing with pressures of work and status

CONSEQUENCES BUT COMBINATION OF ALCOHOL AND COCAINE CAN LEAD TO: Spiral into unemployment Poverty Abuse Collapse of self-esteem Debt Criminal record Poor health Paranoia/anxiety/mental health issues

ALCOHOL AND COCAINE Case Study 1 37 year old male, employed Consumes units in one session Started taking cocaine to “last the pace and keep awake” Cocaine stopped him feeling depressed and worrying about money problems that had arisen over past two years “Wished the weekend could last forever” Got arrested: “best thing ever happened to him” Rude awakening; abstinent from alcohol and cocaine for last five months

ALCOHOL AND COCAINE Case Study 2: 32 year old male, employed, homeowner Strongly into image, appearance, suntan lounge Will spend between £300 -£600 per weekend on cocaine and alcohol After work on Fridays: all day drinking supplemented by cocaine taken in pubs and clubs Will consume 116 units of alcohol over 1 weekend (up to 52 units in one day) and 2-3 grams of cocaine “Don’t think you’re drunk, think you’re cool” End up involved in fighting including broken teeth and black eyes, totally counter to cool image trying to project On Sundays will drink to “unwind” but end up using cocaine again Inevitably having problems with work: Tired, depressed and paranoid Now being given alcohol counselling allied to motivational interviewing, stress management and anger management

ALCOHOL AND COCAINE Case Study 3 20 year old male from deprived area, unemployed Drank heavily along with frequent use of cocaine Motivating factor in taking cocaine along with alcohol was boredom; the combination of the two gave him a greater “buzz” Made him feel happy and upbeat about his life Began having seizures, which stopped immediately he ceased using cocaine Still drinking, but not as heavily Receiving counselling

ALCOHOL AND COCAINE Conclusions: These two substances in combination are potentially lethal within a relatively short period of time It is imperative that assessment and screening picks up dependency on both; the conventional assessment of one primary drug and several subsidiary drugs is not appropriate here: this is Co-dependency The client group will not normally have the typical characteristics associated currently with presentation at addiction services Use of these two substances would appear to be increasing They are used normally as part of a lifestyle and not as a response to deep underlying causes Other problems e.g. criminal record, abuse, unemployment follow on from the use of the substances and not the other way around Addiction workers have to be empowered and trained to deal with both substances Addiction services have a major role in secondary prevention work in preventing alcohol and cocaine use from causing the individual to spiral further into chaos and more resources are needed to do this Location and opening hours of services will have to be considered More research has to be carried out into the combined effects of both and to treat them as their joint use increases