The extent of FASD in Western Australia

Western Australia, like Australia as a whole, does not currently have a screening system or diagnostic tool to identify those at risk of FASD or those already living with the condition. This has impacted attempts to determine the prevalence (how common) of FASD. Numerous population-based studies have been conducted in order to estimate the prevalence of FASD in WA however it is expected that these figures under-represent true numbers.

The largest population-based study to date was conducted by the Telethon Kids Institute and the Western Australian Register of Developmental Abnormalities (WARDA) and looked at the prevalence of FASD in children born in WA from 1980 to 2010. The birth prevalence was calculated as cases of FASD per 1000 births by year of birth. The overall birth prevalence was 0.26 per 1000 births, with 85% of cases being Aboriginal. In addition, many WA FASD cases are 2nd/3rd generations with children having affected parents or grandparents. This highlights the need to educate and inform the public about the dangers of maternal drinking during pregnancy in order to prevent FASD and manage the condition in those affected.

The Liliwan Project
Anecdotal evidence suggests that drinking maternal during pregnancy and FASD prevalence is higher than average in remote Australian Indigenous communities. In 2007, concerned about the welfare of their communities following a wave of alcohol-related deaths, community leaders in the Fitzroy Valley region including June Oscar and others campaigned for alcohol restrictions. Following this, in 2009 they initiated a partnership between Nindilingarri Cultural Health Services, Marninwarntikura Woman’s Resource Centre, The George Institute for Global Health and the Discipline of Paediatrics and Child Health at The University of Sydney Medical School to conduct the landmark 'Liliwan Project' to tackle the issue of FASD.

'Liliwan' means 'all the little ones' and is part of a larger strategy known as 'Marulu' meaning 'precious, worth nurturing' and aims to prevent FASD, diagnose FASD and support affected families with a goal to heal Indigenous communities and create a brighter future for their children.
The results of the Liliwan Project's prevalence study showed that of the 108 babies born between 2002-2003, 13 had FASD. This relates to 120 cases per 1000 births, or 1 in 8 children affected by FASD – the highest reported prevalence in Australia. In addition, 55% of mothers interviewed had drank high levels of alcohol during pregnancy and most were unaware that this could harm the developing fetus. Following this, the collaborative team is now working to educate communities about the risks of drinking during pregnancy and management of the challenges faced by children affected by FASD and their families.


Without a diagnostic tool it is difficult to determine the true prevalence of FASD in WA or in Australia as a whole. Population-based studies are useful for determining prevalence in certain communities but cannot be easily applied nationwide and it is likely that FASD figures are under-reported. 

How do you tackle a child with FASD?

Dealing with a child affected by foetal alcohol spectrum disorder (FASD) can have it's challenges and the effectiveness of any strategies you decide to try will depend on the individual. Never give up on your child, if a strategy isn't working, try something else.

Here are some overall suggestions:

Understand the affects of FASD and adjust your expectations
Understand and remember that the basis for most of the challenging behaviour is caused by brain damage and neurological dysfunction. Even actions that may appear as deliberate or manipulative are often beyond the control of the child. Your child may not always consistently function at a level concordant with their age, and may not do as well at school, act up in social situations or not fully understand the consequences of their actions. This isn't to say that bad behaviour should go without consequences, but you should bear in mind that the child may struggle to learn from their mistakes and repeat the behaviour. Adjust your expectations accordingly, by showing more understanding and support you can encourage healthy and respectful behaviour.

Dealing with bad behaviour
Consequences (as well as rewards) need to be immediate, predictable and unchanging – no 'just this once...' breaks in routine. Rules need to be simple, as do consequences, for example 'you hit = you sit'. An immediate and easily recognisable indicator of behaviour would be giving the child a thumbs up for good behaviour and a thumbs down for bad behaviour.

It is also a good idea to ensure the child has a safe place where they can vent their anger in a physical manner without getting penalised for it. Somewhere where they can't hurt themselves (or others) and a physical activity such as a punchbag or kicking a ball is ideal.

Likewise, in the midst of a tantrum the child may not understand how to stop it and calm down. Use specific instructions such as 'open your eyes' and 'close your mouth' and set up a 'comfort corner' that is safe, comforting and quiet and is used to help them calm down, not as a punishment.

Environment
Instead of trying to change the child, change the child's environment. Children with FASD can become easily overwhelmed and distracted so consider less stimulating environments. In the home, minimize chaotic physical surroundings and think 'less is more'. Visual cues are very helpful for children affected by FASD and increase understanding and assist with memory. Labels, particularly line drawings and better yet drawn by the child themselves, help the child understand what things are for, how to use them and where things go. For example, store things by type, such as all shoes together, all toy cars together, all DVDs together etc and use visual labels so the child can work out where to put things. This can also be used for helping them remember which is the hot and cold tap, which way to turn the door knob, how full to fill the bath etc.
When out and about try and choose less stimulating environments, or if you must go try and do it at a less busy time.

Communication
You need to adapt both what you say and your body language when communicating with a child with FASD. Eye contact is very important as are visual cues. For example, combine 'I don't know' with a big shoulder shrug to help them understand, or use a big cheesy grin when you are happy.
Always try and state what the should do, not what they shouldn't do. Keep instructions clear and to the point, and be specific – instead of 'clean your room' try 'put the clothes in the wash basket' and 'put the toy cars in the car box'. Breaking tasks down into smaller steps helps with understanding and memory.
Try and describe things in a visual way to help them picture it – instead of 'you are interrupting me' say 'your words are bumping into my words'.

Promote positivity and play
A healthy lifestyle including a good diet, regular exercise and fun is beneficial to everyone. Encourage enjoyable activities and play such as art or sports, just always ensure that they are supervised. Playing a team sport may help them in learning how to work with others, make new friends and have fun whilst also being able to displace their excess energy. Focus on the positive, laugh and smile lots, encourage them and reward good behaviour – emotional rewards such as hugs or high fives go a long way.

Routine
Structure, routine and consistency are key when managing a child with FASD. Create good routines for mealtimes and bedtimes and stick to them – no exceptions. Your child may not understand or respond to their body's cues for when they are tired or hungry. Routines anchors activities in time and allows them to predict what comes next.

Have a good support team
Every individual with FASD reacts differently and some techniques may work better than others. Try to ensure the people who your child interacts with understand the nature and challenges of FASD and adapt their behaviour accordingly. Teachers should know your reward and consequence system and stick with it – your child won't necessarily respond to the same punishments as other children. Your healthcare professionals such as your doctor need to understand FASD and the specific challenges it brings. You know your child better than anyone so it is your responsibility to find out what works and make sure it is implemented in all aspects of their life.

Diagnosing FASD

Australia as a whole, including Western Australia, does not currently have a screening system of a diagnostic tool to identify those at risk of foetal alcohol spectrum disorders (FASD), or those already living with the condition. This has impacted attempts to determine prevalence of FASD.

What's more, in regards to the more easily diagnosable and more physiologically recognised foetal alcohol syndrome (FAS), studies on Western Australia show that only 12-16% of healthcare professionals knew the four diagnostic features of FAS. As FASD is less identifiable than FAS it is likely that there is an even greater impact of under-reporting for this condition.

Prevention by screening
One way to reduce the number of cases of FASD would be to utilise screening to identify and refer populations of women of child-bearing age who are planning on getting pregnant, or who are already pregnant, that are also at risk of an alcohol use disorder.
However, a report on FASD found that less than 50% of healthcare professionals routinely ask about alcohol use during pregnancy. This finding prompted a recommendation to the Ministry of Health that women should be screened at each antenatal appointment and that women at risk of heavy alcohol use should receive intervention counselling.

Barriers to diagnosis
The under-reporting of FASD may be due to a difficulty making the diagnosis, a lack of awareness and recognition, a lack of availability of specialists in certain areas and a difficulty to confirm maternal alcohol use during pregnancy. In addition, early diagnosis of FASD can be difficult as evidence of brain damage often isn't evident until the child reaches school age, when learning and behavioural difficulties are more noticeable. This also means that misdiagnosis is common where children may instead be diagnosed with attention deficit hyperactivity disorder ADHD or mild autism.

Evidence suggests that some paediatricians may not being prepared to deal with a diagnosis or may be reluctant due to the associated stigmatisation. In line with this, Michelle Bishop, a Inclusive Education Consultant with the Association of Independent Schools of WA (AISWA), advised that there has historically been a difficulty in getting paediatricians to diagnose FAS/FASD on paper, and attributed this to a lack of clarity around the diagnostic factors

Benefits of early diagnosis of FASD
Being undiagnosed often causes misunderstandings and confusion for both the individual concerned and their friends, family and community. Much needed resources, support and assistance to help those affected manage the condition is missed out on and this can lead to the development of secondary behaviours and the stereotypical labelling of that individual. In addition, the consequences of FASD increase with adulthood as there is less social tolerance for the behaviour.

Early diagnosis of FASD could have many benefits including:

  • Enabling access to interventions and resources that may mitigate the development of secondary problems such as mental health problems, interrupted school experience, unemployment, trouble with the law etc.
  • Appropriate intervention, counselling and treatment for the mother may prevent the subsequent children being affected by FASD.
  • Prompting caregivers to seek diagnosis and support for other previously undiagnosed siblings.

Approach to diagnosis
The Australian FASD Collaboration has developed a diagnostic tool for FASD and funding has been allocated by the government for an action plan to finalise the tool and develop clinical guidelines for use. Following this it will need to be trialled by healthcare professionals. However, in order for diagnosis to be successful a multidisciplinary approach is required. The Department of Health advised that: ‘Developmental delays or disorders can manifest as a single issue or as a cluster of issues requiring multidisciplinary services’. Such an approach would require a combination of inputs from paediatricians, GPs, nurses, social workers, psychologists, speech and language therapists, child care assistants... the list goes on.

How do you recognise FASD?

Drinking alcohol during pregnancy can severely harm a developing foetus and result in Foetal Alcohol Spectrum Disorders (FASD). Alcohol can pass across the placenta and interfere with the normal development of the fetus, affecting cells including brain cells leading to cognitive impairment. The consequences of FASD are lifelong, however the condition itself is 100% preventable by not drinking any alcohol during pregnancy.

FASD may present itself as physical abnormalities, neurological problems with a child’s brain and central nervous system, or manifested in social and behavioural issues and can range from mild to severe depending on the individual. FASD is often called the 'invisible disability' as symptoms of FASD are seldom apparent at birth, and it is often not until school age that learning difficulties and problems with social behaviours arise.

Noticing and observing these common symptoms may help you recognise and identify FASD and get your child a diagnosis and medical treatment.

Physical Symptoms

  • Facial features – wide-set eyes; narrow or small eyes; flat mid face; very thin upper lip; a short, upturned nose; a smooth philtrum (narrow groove between the nose and upper lip).
  • Deformed joints and limbs.
  • Slow growth patterns.
  • Shorter than average height.
  • Vision and hearing issues.
  • Small head size.
  • Structurally abnormal or underdeveloped brain.
  • Problems with major organs such as heart defects and issues with kidneys.
Brain and Nervous System

  • Poor memory.
  • Hyperactivity.
  • Poor coordination and balance.
  • Intellectual disabilities or learning disorders .
  • Trouble with paying attention, or hyperactivity.
  • Trouble processing information.
  • Poor judgement and reasoning skills.
  • Difficulty relating actions to consequences.
  • Rapidly changing moods or anxiety.
  • Speech or language problems.
Social and Behavioural Issues
  • Poor social skills including getting along with others .
  • Difficulty in school, particularly in math.
  • Problems staying on task or working towards a goal.
  • Problems adapting to change.
  • Problems with impulse control.
  • A poor concept of time.
  • Increased risk taking.

These common symptoms may indicate FASD however they also resemble those of other diseases and conditions. If you suspect your child or another might have FAS, it’s important to see a doctor and/ or get a second medical opinion

What is FASD?

Foetal alcohol spectrum disorders (FASD) are a group of conditions that can occur in a person whose mother drank alcohol during her pregnancy. FASD is more common in indigenous communities but can affect anyone who was exposed to alcohol as a fetus.

Alcohol is a teratogen – it is able to pass from the mothers bloodstream, cross the placenta, and enter the baby's bloodstream. Alcohol lasts longer in the baby's bloodstream because a baby's liver metabolises (breaks down) alcohol very slowly. This means the alcohol can interfere with the normal development of the fetus and affect cells including brain cells leading to cognitive impairment..

The characteristic effects of FASD include physical, developmental and neurobehavioural abnormalities. FASD conditions can range from mild to severe depending on the individual. The most severe form of FASD is fetal alcohol syndrome (FAS) which includes facial feature abnormalities as well as the neurobehavioural symptoms.

A person with FASD may have:

  • Abnormal facial features such as a smooth philtrum (flattened narrow groove between nose and upper lip), a flat mid face, a short nose, or a short chin
  • Small head size
  • Shorter than average height
  • Learning difficulties
  • Hyperactive behaviour
  • Difficulty paying attention
  • Poor memory
  • Learning difficulties
  • A low IQ or intellectual disability
  • Speech or language problems
  • Problems at school, particularly with math
  • Difficulty relating actions to consequences
  • Poor judgement and reasoning
  • Problems with major organs such as the heart or kidneys

FASD is often called the 'invisible disability'. Symptoms of FASD are seldom apparent at birth, excluding the facial feature abnormalities that present with FAS. Therefore, it is often not until school age that learning difficulties and problems with social behaviours begin to be noticed. Even then, the problems are often overlooked, ignored, attributed to other conditions or blamed on poor parenting or environment. Paradoxically, the misunderstanding of the unrecognised brain impairment and the associated primary symptoms often leads to the development of secondary behaviours and the stereotypical labelling of that individual.

Not having a diagnosis often causes misunderstandings and confusion and mean that the person misses out on much needed assistance to help them manage their condition. In addition, the consequences of FASD increase with adulthood as there is less social tolerance for the behaviour.

There is no cure for FASD and its effects last a lifetime, however it is preventable. Any amount of alcohol during pregnancy can harm the growing baby. What symptoms occur and how severe they are depend on how much alcohol the mother drank, how often they drank, and at what stage of the pregnancy alcohol was consumed. Other factors such as the age and health of the mother (e.g. if she also smokes) and environmental factors (e.g. stress due to poverty or abuse) can also add to the amount of harm to the developing baby.

The safest course of action is always to avoid drinking any alcohol whilst you are pregnant, as well as if you are trying to get pregnant or when you are breastfeeding.

There are lots of different ways you can stay away from alcohol, and lots of different people who can help when you are struggling, including family, friends, healthcare professionals and support groups. 

What can mothers do to keep away from alcohol during pregnancy?


It can be difficult to change your habits, and if you are used to drinking alcohol it may be challenging to stay away from it once you are pregnant. But you're now responsible for the health and safety of two people, not just yourself, and the only way to remain safe from the risk of your child having FASD is to not touch alcohol at all.

So what can you do instead to distract you from the urge to drink? Below are a few ideas to get you started:

Get creative!
Why don't you start decorating your baby' new room? If you're feeling really creative you could paint a mural design or alternatively create some artwork you think your baby might like and keep it near their crib or hang it on the wall. If painting isn't for you why not take up a new hobby like knitting and get to work making all sorts of new clothes and toys for your little one to enjoy when they arrive?

Go green fingered
Gardening is something you can keep up all year round here in Australia and keeps you healthy. Get outside and plant some flowers, pull up the weeds and mow the lawn and be rewarded with a beautiful backyard. Haven't got a garden of your own? Why not get some pots that you can plant up for in the house? You could even create your own herb garden to use in cooking.

Get some exercise
Playing a sport is a great way to have fun, make friends and get some exercise all at the same time. Go for a walk, whether it's just into town or out in the countryside, there's nothing like a bit of fresh air to clear the mind and it's a great free way to exercise and keep both your body and mind healthy. As well as health benefits exercise also produces endorphins which make you happy! If you aren't up for something quite so active, instead go swimming or do some stretching – your pregnant body will thank you for it!

Create something new in the kitchen
You might crave all kinds of foods whilst you're pregnant so now is the perfect time to try out some new recipes! Always wanted to go a bit more vegetarian or to cook more fish? Why not experiment in the kitchen, it's always fun and rewarding to come up with new dishes to share with friends and family

Start a memory book
Start a book full of photos, advice and life lessons that you want to share with your baby. You can add to it as the baby comes and they can keep it forever and add to it themselves before passing it on to their own children.

Do something for you
Love reading but never have the time? Used to sketch but haven't for years now? Always wanted to write a novel? Why not do something for yourself for a change and do that 'thing' that you've always wanted to do or get back in to an old hobby. Soon enough there will be another person requiring your attention so take the time now to do something for you.



These are just examples but whatever it is that you decide to do you'll not only have great fun but you'll also be keeping your child safe from the effects of FASD so nothing could be more worthwhile.

Stay safe – don't get behind the wheel

In Western Australia 20% of fatal crashes have drink driving as a factor. But the statistics don't do justice to the pain and loss suffered by drunk driving victims and their families. Nothing can take away the grief of the parents who have lost children, husbands and wives who have lost their spouses, kids who have lost their parents.

In Australia, it is an offence to drive while your BAC is 0.05 or above, or zero if you are a novice driver (having held a driver's license for less than two years). Determining how much alcohol affects your BAC can vary significantly from person to person as well as from day to day depending on how much you've eaten, how tired you are, whether you're ill and many other reasons.

In general your BAC should remain below 0.05 if you:

  • drink no more than two standard drinks in the first hour and one per hour thereafter (for men of average size); or
  • drink no more than one standard drink per hour (for women of average size).

However, drinking any amount of alcohol will affect your ability to drive, with a blood alcohol concentration (BAC) of 0.05% doubling your risk of being involved in a traffic accident compared to someone who has not been drinking at all. With a BAC of 0.15, the risk is 20x greater.

It is always best to keep drinking and driving completely separate, use these 4 tips to help stop you from getting behind the wheel.

1) Be responsible and plan ahead
The two most important ways to avoid getting behind the wheel when you have been drinking is to be responsible and plan ahead. You should always make a plan for how you will get home before you start drinking and ensure you have a back up plan. Always keep your phone charged so you can call for alternative transport if necessary or in case of an emergency. If you have any doubts give your car keys to a responsible friend to look after. Once you've started drinking you will likely be less rational so it is important to listen to others and accept their help if they offer it – you might be drunker than you realise.

2) Assign a designated driver
Assigning a designated driver is a common method used to prevent drink driving. This person should ideally remain sober throughout the entire night, so it can be particularly helpful to choose a friend who doesn't drink. Make sure you have this persons contact details with you so you can reach them if you can't find them and make sure you stick to the plan and leave with them at the end of the night.

3) Use alternative transportation
Another option is to use public transport or a taxi to get home. Ideally you should always use a 'buddy system' to avoid travelling alone and make sure that you contact someone once you are home safe. If you are getting a taxi get a friend to wait with you whilst you flag one down. If you're close enough to walk make sure it is a safe, well-lit area and with public transit check the routes and timetables in advance to make sure they still run late at night.

4) If you can't go safely, just stay
If you can't get safe transport to take you home then stay where you are and stop drinking. If you are at a house party ask the host if there is somewhere you can go to sleep. If you are out either ask a friend who lives nearby if you can crash at theirs, or go to a hotel.

What is happening to your body when you have been drinking for over 20 years?


Long-term drinkers are often able to consume higher and higher doses of alcohol without experiencing the short term effects that may cause them to stop. This is known as 'tolerance' and can lead to a dependence on alcohol, addiction or alcoholism. As well as this, when alcohol is broken down by the body its produces toxic by-products which are then transported by the bloodstream to almost all your cells and tissues. Therefore, over-consumption of alcohol over a long period of time can lead to a huge range of different health issues and diseases affecting almost every part of your body.

Liver

Alcohol is one of the leading causes of liver disease in Australia. The build up of fat in the liver, known as fatty liver disease, can begin from a single drinking session. Long-term overconsumption of alcohol can also cause serious alcoholic liver diseases such as alcoholic hepatitis (inflammation of the liver) which can then also lead to alcoholic liver cirrhosis (permanent liver scarring). These diseases prevent the liver from functioning efficiently and could result in a liver transplant, coma or even death. In 2011, 532 citizens of Western Australia were hospitalised due to alcohol-related liver cirrhosis, and the total number of deaths was 59.

Cardiovascular illness:
Approximately 25% of long-term heavy drinkers will develop early onset cardiovascular disease (disease of the heart and blood vessels). Heavy alcohol drinking elevates blood pressure and increases the risk of strokes and heart attacks. Long-term alcohol use also elevates the levels of blood fat leading to coronary heart disease, and can cause cardiomyopathy where the heart gets bigger and loses its ability to contract. Another cause of death in people who are heavy alcohol drinkers is cardiac arrhythmia where the normal rhythm of the heart is disrupted.

Digestive system

Alcohol is toxic to all parts the digestive system. Long-term or heavy alcohol use is associated with higher rates of stomach ulcer disease and gastritis (inflammation of the stomach), pancreatitis (inflammation and scarring of the pancreas) which also impairs the production of enzymes and insulin, and the disruption of the small intestines ability to aid digestion efficiently. There is also evidence to suggest that alcohol can trigger bowel irritation conditions such as IBS (irritable bowel syndrome).

Cancer

Long-term heavy alcohol consumption is a leading cause of cancers including mouth, throat, oesophageal, stomach, bowel, breast and liver cancer. The risk of cancer is directly related to the amount you drink, meaning the more alcohol you drink the greater the risk of developing cancer.

Kidneys
Alcohol acts as a diuretic, meaning it acts on the kidneys and increases urination. Over-drinking alcohol alters kidney function and requires the kidneys to work harder to remove toxins from the bloodstream.

Brain
Drinking alcohol heavily over a prolonged period of time can also cause the death of brain cells leading to brain disorders and decreased mental of physical function. In particular, drinking alcohol as a teenager can be very damaging to brain health as it undergoes a large amount of development during these years.

Musculoskeletal damage

Drinking heavily over a long period of time also affects bones, decreasing their mass and density. This makes them more fragile and more prone to breaks and fractures, as well as increasing the risk of osteoporosis where bones become brittle and cause back pain and even spinal deformation.
Approximately 40-60% of people who drink heavily also report a wasting or weakness of muscles.

Reproductive hormones

For both women and men, long term alcohol abuse can cause reproductive problems. In men alcohol can interfere with testosterone and cause the testes to shrink, and may result in a lower libido, decreased ejaculate volume, sperm count and mobility, impotence, a change in other physical characteristics (reduced cheat and/or facial hair, breast enlargement etc) and even infertility. Likewise, in women the abuse of alcohol can alter the levels of a number of female hormones causing irregularities in menstruation, a lower libido and an increased risk of miscarriage.

Reducing the risk

Thankfully, many of these health care issues can be reversed or prevented when alcohol consumption is stopped (always talk with a doctor before changing your alcohol consumption). If you do not wish to abstain from drinking completely the best way to reduce your risk of alcohol-related diseases is to reduce the amount you drink and adhere to the governmental guidelines.

Alcohol risks for older adults

Many of us may have an older relative or friend that is prone to having one too many. Quite often these events end up being amusing anecdotes to retell at family occasions – 'remember when Granny had too much sherry and fell into the Christmas tree?'. Other times we may just not notice the fact that ever since his wife died Grandad needs a couple of drinks each night to help him sleep. The fact is that anyone at any age can have a drinking problem.

A national survey in 2008 found that approximately 40% of adults aged 65 and older drink alcohol. In addition, a recent report which surveyed 24,000 Australians on their alcohol use, attitudes and opinions found adults over the age of 70 were the most likely to drink daily, continuing a trend that has lasted over a decade.

Some of these older adults may have had a problem with alcohol throughout their life, whereas for others occasional or moderate drinking may have escalated with age. Age-associated events such as identity loss following retirement, inability to engage in activities due to health issues, isolation and loneliness, or grief following the loss of a loved one, can all contribute to older adults developing a problem with alcohol.

Australian alcohol guidelines offer specific recommendations to minimise the potential for alcohol-related harm in the general population however they only suggest that older adults 'drink less'. Other sources recommend no more than 3 drinks on a given day with a maximum of 7 drinks per week, although also state that older people with health issues or that take certain medications should drink less or even not at all.

Older adults have an increased risk of experiencing alcohol-related harm for a number of reasons.

Older adults who continue to drink alcohol with the same habits as they did whilst they were younger will find that their tolerance for it has decreased, and that they experience the effects of alcohol more quickly. This is because as we age our body becomes less effective at metabolising alcohol. Older adults also have a decreased amount of water in their bodies, meaning that the alcohol is less diluted and resulting in a higher blood-alcohol concentration. Combined, these factors increase the risk of unintentional injuries and falls due to drinking.

As we age we are more likely to be taking a range of medications due to health problems. A recent Irish study found that 60% of drinkers over the age of 60 were taking at least one medication that could adversely react with alcohol. Certain medications such as aspirin, sleeping pills, pain medication or anxiety/depression medicine, can interact badly with alcohol and result in dangerous or even deadly events.


As well as certain medications increasing the vulnerabilities to alcohol older adult drinkers face, the underlying health issues themselves can be exacerbated by drinking. Conditions such as diabetes, high blood pressure, congestive heart failure and liver problems, as well as memory issues and mood disorders can all be worsened through drinking alcohol. Older adults who have had a long-term problematic relationship with alcohol are also more likely to experience alcohol-related brain injury (ARBI). Symptoms of ARBI include social isolation, distractibility and confusion, impulsive or reckless behaviour, impaired judgement and depression.

Another issue contributing to the vulnerability to the effects of alcohol abuse that adult adults face is that they are less likely to engage with treatment services. This may be because they don't know where to seek help, they're isolated, or that they lack the mobility to access the services. Friends, family and healthcare professionals may overlook their concerns about older people drinking, being reluctant to bring it up out of embarrassment or with the view of 'they're allowed to let loose now, there's no harm in it'. They may even mistake alcohol-related problems as symptoms attributed with other conditions such as dementia or issues with balance.

Why do women respond differently to alcohol and what are the consequences?


We all know that drinking too much alcohol can be damaging to our health, but evidence shows that women not only respond differently to alcohol compared to men but they are also more vulnerable to alcohol-related diseases.

According to a global study from the National Drug and Alcohol Research Centre, NSW Australia, women have now caught up with men in terms of the amount of alcohol they drink. The study, published in the journal BNJ Open, looked at the drinking habits of four million people over the last 100+ years and reveals that not only are women drinking much more but as a result are doing increasing amounts of damage to their health.

The researchers conclude that increased public health efforts need to be focused on young women.

“Alcohol use and alcohol-use disorders have historically been viewed as a male phenomenon. The present study calls this assumption into question and suggests that young women in particular should be the target of concerted efforts to reduce the impact of substance use and related harms,” they say.

Although women are drinking the same amount as men, we respond differently and are more vulnerable to the effects of alcohol than men.

Women's bodies process alcohol slower than men's do – in fact just 1 drink for a women can have twice the effect as it would do for a man.

Generally women weigh less than men, and their bodies are made up of more body fat and less water. Whereas water dilutes alcohol, fat actually retains it meaning that alcohol remains at a higher concentration and for longer in a women's body than it does in a man's.

Women also have lower levels of the enzymes which metabolise(break down) alcohol – alcohol dehydrogenase and aldehyde dehydrogenase. This means that women absorb more alcohol into their blood stream than men do.

Women are also more likely to be restricting their food intake than men. When food is present in the stomach, a valve closes and prevents the food (and alcohol) from entering the small intestine. Alcohol is less easily absorbed in the stomach. Drinking alcohol on an empty stomach however allows it to immediately pass through into the intestines where it is readily absorbed due to the large surface area.

There is also some debate as to whether differing hormone levels during the menstrual cycle, or the use of the oral contraceptive pill, may affect a women's response to alcohol consumption. However at present the evidence is inconclusive.

As well as responding differently to alcohol consumption, women are also more vulnerable to alcohol-related diseases than men. In particular, women are more likely to contract alcoholic liver disease including hepatitis (inflammation of liver) and are more likely to die from liver cirrhoisis (a chronic disease which progressively destroys the livers ability to help with digestion and detoxification).

Women are also more at risk of suffering from alcohol-induced brain damage including loss of mental function and reduced brain size.

Studies also suggest that excessive alcohol consumption increases the risk of breast cancer. The overall lifetime risk of breast cancer in female non drinkers is 9/100 (9%). For women who drink two standard alcoholic drinks a day this increases to just over 10/100 (10%). For women who six alcoholic drinks a day this increases to approximately 13/100 (13%).

As well as breast cancer female drinkers have an increased risk of osteoporosis, falls and hip fractures, premature menopause, infertility and miscarriages, high blood pressure and heart disease compared to non-drinking women.

Evidence also shows that women are more likely than men to abuse alcohol for self medicating conditions such as depression, anxiety, stress and emotional difficulties. Women can also become more easily addicted to alcohol than men, particularly later in life, and although they are more likely to seek help sooner, more barriers exist in preventing them get the treatment they require.


There are many factors that can affect your individual risk of damaging your health from drinking alcohol, as detailed in a special report published by Harvard Health Publications. As a woman it is important to be aware of the increased risks associated with alcohol consumption for our gender and ideally adapt our behaviour to reduce the incidences and consequences of alcohol abuse.

The effect of alcohol on the teenage brain

During adolescence until your early twenties the brain undergoes vast changes in its development. Two areas that have the most momentous changes are the pre-frontal lobe – which controls complex thought including planning, judgement and and decision making – and the hippocampus – where memories are made.

Drinking during adolescence can severely impact the development and healthy function of these two key regions of the brain. Heavy or extended alcohol use has been shown to reduce the size of the hippocampus by 10% compared to non-drinkers. A high concentration of alcohol in the hippocampus can damage the memory centre and lead to blackouts. Research suggests that the reason teenagers are far more likely to experience blackouts than adults is because at this age the developing hippocampus is very sensitive to damage.

Marc A. Schuckit who co-authored a study on teenage drinking and blackouts stated in a press release that “People don't understand how dangerous blackouts are” and suggests that the 'rite of passage' drinking culture present at that age leads to misconceptions that “blackouts, very bad hangovers, and outrageous behaviour at parties are very funny”. Drinking at this age is widely tolerated, and even encouraged in some situations. But the effect of drinking on an adult brain is vastly different to the effect on a teenage brain and increased understanding and consideration of the consequences is needed.

As well as dangerous damage to the hippocampus, alcohol can also cause the immature development of the pre-frontal lobe, resulting in poor judgement, a lack of consideration for consequences, impulsiveness, increased risk taking and miscommunication. This in turn can lead to to accidental injuries which are one of the leading causes of death amongst teenagers.

In light of the recent evidence the National Health and Medical Research Council (NHMRC) concludes that alcohol should not be consumed below the age of 18, with children under the age of 15 at the greatest risk. Between the ages of 15 and 17 it is advised that efforts are made to delay the drinking of alcohol for as long as possible.

However a new study has suggested that children who are introduced to alcohol by their parents before the age of 18 are less likely to begin binge-drinking in the following years compared to children who were given alcohol by their peers, although Professor Richard Mattick who led the study still advises that teenagers should “delay drinking as long as possible” in order to reduce harm due to the continuing brain development.


Unless we as a society change our view on teenage alcohol consumption it will be a difficult task to prevent teenagers drinking before they turn 18. Whether it is better to continue to try and delay drinking until late as possible or instead to choose to introduce your children to alcohol before they turn 18 is essentially a double edged sword, and much more research required before we have any hope of finding a solution to this problem.

What is going on inside our brain when we drink alcohol?

Many of us aren't a stranger to a glass of wine or a cheeky pint after a stressful day or a long week at work. We crave that feeling of unwinding and being able to relax, letting go of our worries and inhibitions so on occasion this 'one drink' turns into two, then three... and so on. We can generally easily recognise the outward signs of drunkenness – the slurred speech, slower reaction times, swaying or loss of balance, along with poor judgement or even memory loss. But how about what is happening internally? In what ways does alcohol affect our brains to cause these changes in behaviour?

Below is a useful summary from the website How Stuff Works describing how alcohol affects your brain:

Alcohol affects our behaviour by changing the levels of neurotransmitter in the brain. Neurotransmitters are chemical messengers that either excite (stimulate) or inhibit (suppress) brain functions. The excitatory neurotransmitter glutamate increases brain activity and energy levels, whereas inhibitory GABA reduces energy levels and calms everything down. Drinking alcohol alters the levels of these neurotransmitters, suppressing glutamate and increasing GABA, which results in a complete slowing down of the brains processes including speech, thought and movement – hence the slurred words, slow reaction times and stumbling.

Have you ever wondered why drinking alcohol makes you feel happier or more relaxed (initially at least)? That's because alcohol increases the release of dopamine in the brains 'reward centre' – the area of the brain that is stimulated whenever you engage in a pleasurable activity. This is known as the 'dopamine effect' and indicates why you may crave that drink at the end of the week – it's not necessarily the drink you want, but the feeling of happiness that comes with it. This trick alcohol plays on the brain is also responsible for addiction, with many people turning to alcohol to feel better. Over a prolonged period of time that dopamine effect diminishes , but by then it can be too late with the now-addict having a compulsive need to drink in order to try and feel better.

Below is a brief description of how alcohol affects certain regions of the brain:

Central Nervous System
The CNS consists of the brain and the spinal cord. The brain controls the function of thought and this is transmitted through our nervous system to carry out almost all functions of our body. Alcohol slows down the CNS causing you to think, speak, react and move more slowly.

Cerebral Cortex
The cerebral cortex is responsible for consciousness and processing information from a persons senses. Alcohol slows down the functions of the cerebral cortex and therefore prevents you from thinking clearly and reduces inhibitions.

Cerebellum
The cerebellum is the centre for coordination, awareness and movement and it is alcohols affect on this brain region that causes loss of balance.

Hypothalamus
The hypothalamus is the housekeeper and controls all the day to day chores. As alcohol affects the hypothalamus we have an increase in the urge to urinate, thirst and hunger – no wonder that greasy kebab sounds so good at the end of the night!

Hippocampus
Memories are made in the hippocampus and after just one or two drinks alcohol can affect this region of the brain and make it more difficult for you to remember names, phone numbers etc. Drinking a lot of alcohol quickly can lead to blackouts – short-term memory loss that cannot be recovered.


There's nothing wrong with having an occasional alcoholic drink, but we should be aware of how and why that alcohol impacts our body. Misuse of alcohol and long term drinking can seriously damage your body, including your brain, so it is important to understand the risks involved and know when to stop.

Six tips on keeping your team performance at its best


Effective teamwork is crucial in the healthcare sector, whether you’re in the operating theater or working on the wards, as the public’s health and well-being are in your hands. Poor teamwork and miscommunication can disrupt procedures, lead to inaccuracies or cause unnecessary additional stress, overall contributing to a poor healthcare service received by the patient.
A good friend of mine is a hospital pharmacist, and teamwork communication issues often arise while she’s on call. She’s had to deal with anything from the patient’s medicine order not being put through, to miscommunication over scheduling to paperwork being filled out incorrectly. She’s even had calls from people asking her what to do when they can’t log on to the computer!
An essential component of team work is understanding who to direct your question to to minimise the amount of disruption caused. Solely working for your own individual gains causes more problems. When colleagues are put under unnecessary stress, they, in turn, take it out on another colleague and so on until frustration and disruption trickle down throughout the whole team.
A team that works together performs best together. Use these six tips to keep your team performance at its best!
1) All for one and one for all
We all know that working as a GP or Nurse has it’s challenges but teamwork needn’t be one of them! It is important to remember that you all have a common goal – to deliver excellent health and medical care to the patient. Everyone should be able to see how their colleagues roles, as well as their own responsibilities as an individual, add value to the practice. Although you are a team, you are made up of individuals who all excel at different skills and yet may fall short on others. Knowing your team members and understanding their strengths and weaknesses is the first step to ensuring the smooth running of the practice.
Some people are put off from visiting their Doctor due to embarrassment or mistrust. Finding a well-coordinated team and a Doctor who listens to them will ease their concerns and fears and allow them to get the care they need. However, a practice that has poor team communication may end up cancelling or rescheduling appointments which could lead to the patient experiencing increased anxiety and stress and could even prevent patients from making future appointments. All working together for a common goal brings unity and creates a supportive working environment. As the three musketeers would say – All for one and one for all!
2) Have an open door policy
Practicing an open door policy encourages communication and transparency. It is important to ensure that all members of staff feel that they are respected, their opinion is valued and that they can bring up any queries or issues they may have. For example, imagine a medical receptionist who has been working at the practice for many years and feels that her skills and experience entitle her to a raise. She may feel uncomfortable talking about money, and having a team where open communication is not encouraged may create an atmosphere where she feels unable to broach the subject and this could lead to resentment. If on the other hand she works in a practice where an open door policy encourages two-way communication and feedback she may feel more confident in approaching the practice manager, leading to an open discussion resulting in a raise or else an understanding of her next steps to secure a raise in the future.
3) Maintain clarity
Excelling at communication requires clarity as time can be easily wasted when people aren’t sure what they are supposed to be doing and why. Imagine a new member of staff has just joined the practice and he spends 2 hours completing a task exactly as he would at his previous job only to find out that things are done completely differently here. As well as embarrassment and frustration, this has caused a lot of time to be wasted, especially if the task needs to be repeated with another member of staff supervising the process. Everyone needs to understand exactly what their roles are and what responsibilities are expected of them, and asking for clarification if they are unsure should be encouraged.
4) Say no to group meetings
Working in the medical field usually means you have very little time to spare as there is always something you need to be doing! One thing that can be a huge waste of time is group meetings – the whole day has to be planned around them, they often overrun, and half of the time is spent discussing something with no relevance to your work. Instead, why not try to keep meetings specific and only invite the individual concerned or the people relevant to what you are discussing. You could also ban chairs – meetings are much more likely to stay on task and progress quickly if everyone involved is standing up!
5) Develop team bonding
A report on the Harvard Business Review suggests that reintroducing team coffee breaks can promote productivity. Sitting down once a week with your team mates in an informal manner will encourage communication through the art of conversation. Allowing space for personal conversation will strengthen bonds and build rapport within the team, and as with all groups with a common interest, conversation about work will naturally arise. Try scheduling one in every Monday to allow progress from the previous week to develop into this weeks goals. Alternatively, if you really want to boost team spirit try organising team building activities which can range from quick 10 minute ‘games’ to exercises that last a few hours or even a whole day. Learning how to work together and solve problems as a team is an excellent way to develop strong positive group dynamics and good working relationships and has been shown to improve performance and productivity. Personally I recommend ‘Escape Rooms’ where you have one hour to escape a themed room by working as a team to solve a series of puzzles – as well as practising your team work and problem solving skills you can have a lot of fun!
6) Tackle conflict
Conflict is an inevitable part of life and can be particularly challenging when working with others, whether it arises between two doctors with differing opinions on how to treat a patient or administration having to deal with scheduling issues. Even if you don’t get on personally with someone you need to work well together professionally. When I was on placement I worked with a gastroenterologist and a medical researcher who didn’t get on and did all they could to avoid each other. This resulted in me being the ‘go-between’ as we were never all in the same room to discuss progress, and it caused many delays and disruptions to the project. Negative group dynamics may contribute to the cause but it is often the mishandling of that conflict that causes it to escalate. Conflicts should never be ignored but rather acknowledged immediately and tackled head, dealing directly with the source rather than gossiping and complaining behind someone’s back. All sides need to listen to and respect each other and understand that you all have the best intentions and a common goal. Cooperation is key!
Working in a team can be difficult at times but by putting these tips into practice you will be able to harness the talents of a diverse group of people and easily overcome challenges. In the healthcare industry we are all passionate about helping others so let’s work together to extend that to getting the best out of ourselves and each other.

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