Tag: alcohol

Last drinks at the Paradise Motel

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Image: Michael Jarmoluk, Pixabay.com

As I gave up drinking alcohol some 36 years ago, it was probably not surprising I forgot the essential ingredient for a house-warming party.

“Um,” said She Who Trusted Me with the Catering, “What about the ice – for those who are bringing something to drink?”

Off I went on a mercy dash to buy a bag of ice. The first guest had arrived before I returned and showed me the best way to prepare ice for an esky (drop it on the concrete driveway).

There was quite a bit of wine left over at the end, which suggested our guests were moderate drinkers (or intended that wine be left for mine hosts). In all, it was an enjoyable christening of the Paradise Motel (named after one of my more fanciful songs).

My mind turned to this subject with a timely new report from the Australian Institute of Health and Welfare about the effect of drugs and alcohol on the health of the general public.

This intersected nicely with an observation made by an emergency medicine veteran. His view was that if everyone gave up drinking alcohol and taking illicit drugs, Emergency Department staff would then have ample time to care for people who are genuinely sick.

The National Hospital Morbidity Database showed that in 2017-2018, there were 136,000 same day or overnight hospital admissions for a drug-related principal diagnosis. On its own, alcohol accounted for 53% of these admissions. No prizes for speculating about the other 47%.

Ah, you are thinking, the wowser’s view: “all health problems caused by drugs and alcohol are self-inflicted.”

Perhaps the ER veteran’s views would also include people whose health has deteriorated over time as a result of smoking tobacco.

The AIHW report confirms a noticeable decline in the use of tobacco in the 14 and over age group (from 24.3% in 1991 to 12.2% in 2016). Despite this impressive statistic, smoking is still the leading cause of cancer in Australia (22% of the cancer burden).

Alcohol abuse, however, is a far more worrying problem. The World Health Organisation found that 3 million deaths result every year from harmful use of alcohol (5.3 % of all deaths). The harmful use of alcohol is a factor in more than 200 disease and injury conditions.

It is generally accepted that (excessive) alcohol consumption and its aftermath contributes to more than 6000 deaths in Australia every year.

You’d never know it, but sometimes in the privacy of our own lounge room, we watch the reality TV show, RBT (the ex-probation officer and the (sober) ex-journalist relishing the opportunity to make snide comments). We did sympathise to a degree with the young chap who freely admitted to using cannabis every day (‘but I don’t drink alcohol at all’). Nevertheless the law finds that he is still driving under the influence and he thereby paid a price.

A month or so ago I had to drive to Toowoomba for the day and was stopped by a roadside breath test crew. Did I say this was at 9.10am on a weekday? She Who Still Enjoys a Drink or Two observed that such roadside blitzes often catch people who are still over the blood alcohol level limit after a night of partying.

The AIHW report found that while the majority of Australians drink alcohol, the overall daily intake is on a downward trend. The proportion of people drinking in excess of lifetime risk guidelines continues to decline.

The apparent consumption of alcohol in 2017-2018 was equivalent to an average of 2.72 standard drinks per day per consumer of alcohol aged 15 and over.

That is a fair way below the binge drinking and ‘pre-loading’ that goes on among the must-get-drunk-to-socialise cohort.

Almost 40% of Australians aged 18 and over exceeded the single occasion risk guidelines by consuming more than four standard drinks in one sitting. About 1 in 6 (17.4%) Australians aged 14 and over put themselves or others at risk of harm while under the influence of alcohol in the last 12 months.

I guess these are the people the RBT teams are out to catch.

Alcohol consumption inevitably increases on festive occasions like Christmas, New Year and public holidays like Australia Day. Special birthday and anniversaries are also vulnerable times for those who find it difficult to stop after two or three.

So how much is too much? The Australian Bureau of Statistics defines binge drinking as more than 7 drinks a night for men, and more than 5 for women. The NHMRC Australian Alcohol Guidelines defines excessive drinking as more than 4 standard drinks per night.

So how did we all go after those festive season parties? Many start at home and stay there. Others start with a few at-home drinks (sometimes known as pre-loading), before partygoers wisely catch taxis to the next venue, where the drinking continues.

Drink-driving laws have done much to help drinkers self-regulate. Many of the people stopped by officers on RBT were consciously monitoring their drinking.

But not everyone is as keen to avoid losing their drivers’ licence. In my court reporting days for a daily newspaper, I recall cases where the defendant was found to have a blood alcohol level of (extreme example) 0.34 – quite a long way beyond the Australian limit of 0.05). Quite often people with this level of blood alcohol have been found asleep at the wheel of a stationary vehicle (and a jolly good thing too).

Not that it should fall to me to make such withering observations, but I sometimes wonder how the evening ended for three young women, so much under 18 and under the influence after the footy (about 10pm) that they took off their high heeled shoes and wobbled down Milton Road.

“Are we going clubbing?” I heard one of them ask a less-than sober friend. “Do you reckon we should we catch a cab to Valley or walk?”

Given that a round of four beers at the footie will set you back $40 or so, this type of drinker is unlikely to belong to the ‘average’ household that drinks $32 worth of alcohol per week. Did you notice that the NIHW report implicates adolescents as young as 14? In a country where the legal drinking age is 18, this implies that older friends (or family) are buying alcohol for the under-agers.

The AIHW report found that 9.1% of adolescent males and 6.8% of females aged 12-17 exceed the adult guidelines for single occasion risk.

Young people are arguably more likely to be influenced by alcohol advertising at major sports events, prompting targeted opposition from alcohol education lobbyists.

You might have heard tennis ace Nick Kyrgios say to John McEnroe after Tuesday’s night’s Australian Open win – ‘he’s had too many beers’ – a response to a spectator who yelled out something incomprehensible.

The National Alliance for Action on Alcohol is taking on the Australian Open, urging organisers to consider the role of advertising in youth drinking. An e-petition to this effect has so far gathered 151 signatures.

Another critic observed: “…exposure to alcohol advertising places children at greater risk of drinking earlier and at more dangerous levels than they otherwise would.”

This is a long way from my youth in 1960s rugby-mad New Zealand, where drinking beer to excess was considered to be a badge of manhood. It’s not, but I guess the statistics in 2020 show that more of us realise that now.

More reading: alcohol and mental health

https://bobwords.com.au/mental-health-psychiatrist-walks-bar/

Mental Health Week – a psychiatrist walks into a bar

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A mural by Giudo van Helten on 30m grain silos in Coonalpyn, South Australia. https://flic.kr/p/XUsAK9 Steve Swayne

You wouldn’t always associate grain silos with the national funding crisis facing Australia’s mental health sector. Mental Health Australia chief executive Frank Quinlan did just that, using the silo analogy to lament the distribution of funds that so often see alcohol and drug problems and mental health problems dealt with separately.

He cited the 2016 Australian Institute of Health and Welfare report on alcohol and drug use which states that one in four people who abuse substances had also been diagnosed or treated for a mental illness.

Mental illness was the subject of a short film shown at Gympie’s Heart of Gold Festival last weekend. A psychiatrist is late for his 11am appointment with a new patient – a man who suffers from delusions that he is…a psychiatrist. It sounds like a man walks into a bar joke, but in this case, the clever premise for a 13-minute film by Josh Lawson (actor/writer) and Derin Steele (director).Lawson and Steele control the farcical plot and sharp dialogue with the panache of John Cleese and Connie Booth.

The film won the best Australian short film award at the Heart of Gold Festival, the 10th year of this splendidly curated short film festival held in Gympie.  I’m happy for the writer/director that they won best Australian short for a film by using humour to have something to say about psychiatry and mental illness.

Seeing is believing – maybe

Unlike physical disabilities (cerebral palsy, MS,  spina bifida, brain or spinal cord injury, epilepsy, muscular dystrophy or the long-term effects of a serious stroke), mental illnesses are hardly ever that obvious. Once the mentally ill person’s latest acute episode has settled, they can present in society, well, as normal as you and me.

The point is well made in “The Eleven O’Clock” where the secretary (a temp), accepts what she sees as “normal”.

There is, alas, nothing funny about mental health, its proven links to alcohol and drug abuse and a lack of co-ordinated national funding that leaves so many mentally ill people in a cyclical holding pattern.

As Mental Health Australia chief executive Frank Quinlan wrote in a recent MHA newsletter, separate plans and strategies to deal with mental health perpetuate the silo model of funding.

Quinlan writes that Primary Health Networks, set up in 2015, offer an opportunity to genuinely integrate and co-ordinate programmes and services.

“But this is only going to happen if we can break down the boundaries that see separate streams of funding for drug and alcohol issues, mental health issues and various psychosocial supports.”

The 2016 AIHW report, which canvassed 23,772 people, noted that 27% of illicit drug users have a mental health issue, compared with 21% in 2013. Mental illness occurred in one in four users of ecstasy and cocaine and in 42% of methamphetamine users (29% in 2013).

The abuse of amphetamines and derivatives doesn’t let righteous boozers off the hook. One in five people who drink alcohol at risky levels have also been diagnosed or treated for a mental illness. That was a 25% increase over three years.

Patrick McGorry, professor of psychiatry at the University of Melbourne, says the overlap between mental ill health and substance abuse is enormous, yet treatment for drug abuse and mental health has been “progressively de-funded, de-medicalised and split off from mental health care.”

He told ABC News: “Mental ill health drives self-medication with drugs and alcohol and yet virtually no services are equipped to respond to this toxic blend.”

Meanwhile, many community mental health programs, be they government-funded units or NGOs, have been ring-fenced within the National Disability Insurance Service. This means that the mentally ill who do not qualify under the NDIS may be without support outside of acute hospital wards. The Federal Government set aside $80 million in the May budget with the intention of plugging the gap.

Sebastian Rosenberg, Senior Lecturer, Brain and Mind Centre at the University of Sydney, said the federal budget’s promise of $115 million in new funding over four years was one of the smallest investments in the sector in recent years. The Council of Australian Governments (CoAG) added more than $5.5 billion to mental health spending in 2006, while the 2011-12 federal budget provided $2.2 billion in new funding.

“In 2014-15, mental health received around 5.25% of the overall health budget while representing 12% of the total burden of disease,” Rosenberg wrote in The Conversation.

“(These figures) speak to the fact mental health remains chronically underfunded. Mental health’s share of overall health spending was 4.9% in 2004-05. Despite rhetoric to the contrary, funding has changed very little over the past decade.”

Rosenberg says Australia lacks a coherent national strategy to tackle mental health.

“New services have been established this year, but access to them may well depend on where you live or who is looking after you. This is chance, not good planning.”

This is where the silo analogy reappears: those with the gold key to the silo door will get a quick fix. Treasurer Scott Morrison said the $80 million allocated over four years for ‘psychosocial services’ was for Australians with a mental illness such as severe depression, eating disorders, schizophrenia and post-natal depression. The funding, which seeks matching contributions from the States, includes those who had been at risk of losing their services during the transition to the NDIS.

Some 230,000 Australians with severe mental illness have chronic, persisting illness and most have a need for some form of social support. This can range from low intensity or group-based activities to extensive and individualised support. The latest data available on this subject suggests that 22% of people with psychosocial disabilities have been unable to meet access requirements for the NDIS. (NDIS/COaG Quarterly report).

So $20 million a year won’t go very far, although as much as $160 million a year could be available if all States chip in. But each State and Territory will have to retain responsibility for what was previously known as community mental health services.

Still, you’d agree it’s a better application of taxpayer funds than the $20 million spent in 2015 on charter flights to and from detention centres on Nauru and Manus Island.

From the archives