Alcohol
Alcohol is the most widely used drug in Australia today. Drinking alcohol in moderation (up to 2 standard drinks for both Men and Women) is acceptable for many people, but regularly drinking more than this may be harmful to mental and physical health. One standard drink equals 10 grams of alcohol; which roughly translates into one glass of full strength beer (285 mls) or two 285ml glasses of light beer, or five 285ml glasses of super light beer. It is also equal to one small (100ml) glass of wine, one measure (30ml) of spirits or one 60ml glass of fortified wine such as sherry or port.

What are alcohol problems?
When you drink more than the recommended limit of alcohol on a regular basis, this may have a harmful effect on many of the body's systems and organs, including the brain. Many illnesses such as heart disease, certain cancers, kidney and liver disease can be caused by alcohol abuse.

In terms of mental health, alcohol can become a problem when you continue to drink despite the problems caused by it. Over time, the body builds up a tolerance to alcohol, meaning that you have to drink more to get the same effects - this can lead to physical addiction to the alcohol. Sometimes people use alcohol as an escape from difficult situations or feelings and eventually lose their ability to cope with day to day life without drinking. Areas of the person's life such as personal relationships, family responsibilities, work, accommodation and education may become neglected as the person's use of alcohol becomes more and more important to them.

Many assaults, homicides, accidents and incidents of domestic violence are precipitated by the use of alcohol. Drug use is a factor in about one in five of all deaths in Australia. According to recent statistics in Australia, 23,313 deaths were attributed to drug use in 1998. Of these, 19, 019 deaths were related to tobacco use, 3,271 deaths related to alcohol use and 1, 023 deaths related to illicit drug use (Australian Drug Foundation). Accidents are more common when people are intoxicated and are unable to pay attention to, and respond appropriately to, dangerous situations such as driving a car or crossing a road. A large number of pedestrians involved in traffic accidents in NSW are affected by drugs or alcohol.

Some people find it difficult to control their use of alcohol and find themselves drinking more than they intended to. People drink to relax, have fun, fit in with a group, out of curiosity or to escape from physical or emotional pain.

What are the Symptoms?
Alcohol is a ‘depressant’ meaning that it slows down the nervous system. Depressants tend to make the person's thinking slower and can make them drowsy and uncoordinated. Emotions that the person is feeling tend to be intensified, so if they are feeling angry for example, they may feel angrier.

Signs that you may have a problem with alcohol include:

1. drinking heavily when you are disappointed, under pressure or have had a quarrel with someone
2. being able to handle more alcohol now than when you first started to drink – building up a physical tolerance to alcohol
3. memory loss and forgetting what happened when you were drinking
4. drinking alone or ‘sneaking in’ extra drinks so that other people don't notice how much you are drinking
5. feeling uncomfortable if alcohol is not available
6. feeling guilty about your drinking
7. drinking earlier on in the day, or first thing in the morning
8. a family member or close friend has expressed concern or complained about your drinking
9. having memory 'blackouts' recently
10. often wanting to continue drinking after your friends say they've had enough
11. when you're sober, sometimes regretting things you did or said while drinking
12. trying different ways to stop drinking without success
13. legal problems related to your drinking, such as driving under the influence of alcohol or assaulting someone whilst drunk
14. avoiding family or close friends while you are drinking
15. having more financial, work, school and/or family problems as a result of your drinking
16. eating very little or irregularly during the periods when you are drinking
17. having the ‘shakes’ in the morning and finding that it helps to have a another drink, tranquiliser or other medication
18. sometimes staying drunk for several days at a time
19. after periods of drinking, sometimes seeing or hearing things that aren't there
20. feeling depressed or anxious before, during or after of heavy drinking

Alcohol Dependence
Physical dependence on alcohol occurs when your body becomes so used to alcohol that you have to drink more and more to get the same effect. When there is no alcohol in your body, symptoms of dependence occur, including the following:

• Nausea, vomiting and headaches
• Trembling or shaking
• Sweating profusely
• Craving for more alcohol
• Flu-like symptoms

What is the cause of alcohol problems?
Problems are usually caused by a combination of factors unique to each person:

• Genes – research indicates that alcoholism may have a genetic basis
• Family history – alcoholism tends to ‘run in families’ although it is unclear whether this is due to genetic factors or learned behaviour that is passed down through generations
• Stressful or traumatic life experiences can be the catalyst for the person drinking to excess
• Social factors – the availability and price of alcohol affects how much it is used, also whether or not alcohol is socially acceptable

What help is available?
Detoxification
If you are physically dependent on alcohol, you may need to get rid of the alcohol in your system. This is known as detoxifying or ‘detox’. There are various ways to detox; it can be done at home with assistance from your doctor or in a medical facility such as a hospital or specialised detox service. Medications can sometimes be given to help ease the withdrawal symptoms.
NOTE: If you experience delirium tremens (the DTs, or the ‘shakes’) seek immediate medical help.  In extreme cases this can be fatal.
Rehabilitation
After detoxing, it is important to make life changes that will help you avoid starting drinking again.  Rehabilitation involves counselling, education, living skills and other supports.
Alcoholics Anonymous (AA) is an international fellowship of men and women who have had a drinking problem. It is non-professional, self-supporting, non-denominational, multiracial, apolitical, and available almost everywhere.  Meetings are attended on a regular basis and members go through their own journey of the ’12 step’ program.  Many people all over the world have found A.A. to be helpful and effective but it is not for everyone.  The best thing to do is to learn about it and decide whether the program sounds right for you.

What can I do to help myself?

• Talk to someone about your drinking and be clear about the reasons you want to stop or cut down.  It helps to be clear on your motivation to stop drinking
• Decide on your goal – do you want to stop completely, or simply reduce the amount you drink?
• Think about the reasons why you drink and what benefits you get from alcohol.  Can you think of other ways of getting that benefit?
• Monitor your alcohol intake in units and try to stay below the maximum recommended alcohol intake
• Take it one day at a time and don’t give up if you relapse.  Most people find that it takes several attempts to stop drinking so don’t be disheartened – just resolve to try a bit harder tomorrow

Families and friends
It can be frustrating when someone you love is drinking too much, particularly as it is impossible to force someone to stop drinking or to receive treatment.  There are some things you can do that may help:

• Don't try to protect the alcoholic from the results of his or her drinking.  By making excuses for the person, you are ‘enabling’ them to continue drinking without experiencing the natural consequences. For example, your loved one might ask you to call in sick to their workplace for them when they are unwell with a hangover.  If you agree, they do not have to accept the consequences of their drinking and may see no reason to stop.
• Find out about local treatment options and pass this information on
• When talking to your loved one about the problem, use specific, recent examples of their problem drinking to support what you are saying.  The best time to approach the person may be soon after an alcohol-related incident has occurred
• Maintain your own boundaries and be clear on what you will and will not tolerate.  Explain to the person drinking what you will need to do if they don’t get help.  This should not be done in a ‘threatening’ way, but in a way that tells the person that you have limits and that there are consequences of their drinking
• Consider contacting Al-Anon for support.  This is a program adapted from Alcoholics Anonymous and helps family members to cope with the impact of a loved one’s drinking.

Further Reading
Over the Influence: The Harm Reduction Guide for Managing Drugs and Alcohol by Patt Denning, Jeannie Little and Adina Glickman, Guilford Publications, Inc, 2003, ISBN: 1572308001
Recovery Options: The Complete Guide, How You and Your Loved Ones Can Understand and Treat Alcohol and Other Drug Problems by Joseph Volpicelli and Maia Szalavitz, Wiley, John & Sons, 2000, ISBN: 047134575X
Addiction Workbook: A Step-By-Step Guide to Quitting Alcohol and Drugs, by John O’Neill and Patrick Fanning, New Harbinger Publications, 1996,
ISBN: 1572240431

Where to get help

The Alcohol and Drug Information Service (ADIS) can provide details of detoxification and rehabilitation options in NSW:
Tel (02) 9361 8000 or 1800 422 599
http://ndarc.med.unsw.edu.au/ndarc.nsf
The following website lists all NSW treatment facilities
http://www.nada.org.au/agencyresults.asp
See your family doctor

Other Drugs
Drugs are substances that have an effect on the brain to cause an altered mental or emotional state.  These include drugs which are only legal when they have been prescribed by a doctor – such as minor tranquilisers – as well as illegal drugs such as heroin, cocaine, marijuana, ecstasy or amphetamines.
Legal problems aside, some people use drugs without coming to any physical or mental harm.  However, many people find that their drug use causes them problems with their physical and/or mental health.

• If a person has no physical tolerance to the drug, they may take more than their body can handle and overdose
• The person may not know how to cope in an emergency such as severe intoxication, overdose or bad reaction
• The person may be arrested for drug offences, affecting areas of their lives such as employment, travel and liberty
• Illicit drugs are not subject to any kind of price or quality control and users can never be sure about the strength, safety or purity of the drug they are taking.  Some drugs are mixed with other substances before being sold to bulk them out and increase the dealer’s profits, these added substances may be as harmless as sugar or as harmful as powdered brick dust
• The person may continue to use the drug and become addicted
• One of the problems associated with drug use is the harmful physical effects.  Drug use can lead to health problems such as emphysema, cancer, HIV and hepatitis
• Family and relationship problems may arise when the person using drugs refuses to recognise that their using causes problems to those around them and themselves.  Family members may be lied to or manipulated into giving the person money to fund their habit.
• Legal problems arise from the manufacture, possession, use and distribution of illicit drugs, with heavy penalties for some offences.  The person may also commit crimes such as theft in order to pay for their drug habit

• Financial problems are common as alcohol and illicit drugs are usually expensive, leaving less money for things such as rent, bills, food or clothing.

What are the symptoms of drug problems?
A person’s drug use becomes problematic when:

• They develop a tolerance to the drug, needing to take larger amounts to get the desired effect
• They experience withdrawal symptoms when not using the drug
• They feel unable to reduce or stop using drugs
• They spend large amounts of their time and energy on obtaining, using and recovering from, drugs
• They know that the drug is causing ongoing physical or mental problems but keep on using despite this.

Stimulants, including amphetamines, cocaine, party drugs such as Ecstasy.  These speed up the functions of the nervous system.  The person using these drugs often appear wide awake, full of energy and more talkative than usual.  Emotions tend to be intensified, so if the person is feeling happy and having fun, that experience is enhanced.

Hallucinogens, including LSD (‘acid’), magic mushrooms, PCP, ketamine.  These affect the person’s perception, i.e. they see, hear and feel around them things that do not really exist.  The person’s behaviour may appear confused or bizarre and their thoughts and conversation may be difficult for others to follow.

Depressants, including alcohol, cannabis, opioids such as heroin, solvents and inhalants such as petrol or glue.  These slow down the nervous system.  Depressants tend to make the person’s thinking slower and may make them drowsy.  Emotions that the person is feeling tend to be intensified, so if they are feeling angry for example, they will feel angrier.

What are the causes of drug problems?
It is likely that a combination of factors affect whether an individual will have problems with drugs.  There may be a genetic tendency towards becoming addicted to substances and the person’s social and personal circumstances also play an important role.
People who have a mental illness are more likely to take drugs – this is known as ‘dual diagnosis’.  This is sometimes because they feel the drug helps alleviate symptoms of the mental illness – this is called ‘self medicating’ and is not helpful.  There may also be a ‘downward drift’ factor at play – people who have a severe mental illness may find themselves living and/or mixing with other marginalised people who use drugs.

What help is available?
Detoxification, rehabilitation, medication and ongoing counselling and support are all parts of treatment for drug addiction.  Narcotics Anonymous is a 12-step program developed along he lines of Alcoholics Anonymous.  Treatment will depend on the severity of your addiction and the substance involved.

What can I do to help myself?

• Educate yourself about drugs and addiction through reading books and reputable websites such as those listed below
• Take it one day at a time – it may be too overwhelming to think of staying away from drugs forever.  Make a promise to yourself not to use drugs today and worry about tomorrow, tomorrow.  It takes the majority of people more than one attempt to stop using drugs, so don’t label yourself a failure if you lapse.
• Allow drug treatments, such as rehabilitation, time to work.  Staying in treatment for longer periods helps avoid relapse.
• Society holds a strong stigma against people who are addicted to drugs.  Try to remember that you are more than just your drug addiction; you are also a son or daughter, a parent, a friend, someone with their unique set of hopes, fears, dreams, strengths and weaknesses.  Getting to know and accept yourself as you are will help you to stop using drugs.

Families and Friends
It can be frustrating when someone you love is using drugs, particularly as it is impossible to force someone to stop using or to receive treatment.  There are some things you can do that may help:

• Don't try to protect the user from the results of his or her drug use.  By making excuses for the person, you are ‘enabling’ them to continue using without experiencing the consequences. For example, your loved one might ask you to call in sick to their workplace for them when they are suffering a drug ‘come-down’.  If you agree, they do not have to accept the consequences of their drug use and may see no reason to stop.
• Find out about local treatment options and pass this information on
• When talking to your loved one about the problem, use specific, recent examples of their drug use to support what you are saying.  The best time to approach the person may be soon after a drug-related incident has occurred
• Maintain your own boundaries and be clear on what you will and will not tolerate.  Explain to the person what you will need to do if they don’t get help.  This should not be done in a ‘threatening’ way, but in a way that tells the person that you have limits and that there are consequences of their drug use.
• Consider finding support and understanding from a support group for the families of drug users, such as Family Drug Support.

Further reading
The following titles are available through Mental Health Information Service 1300 794 991:

• Dealing with Heroin Use
• Dealing with Cannabis Use
• Mulling It Over (marijuana)
• Drugs in Focus
• Double Trouble (dual diagnosis)

Or from bookshops:
How to Quit Drugs for Good: A Complete Self-Help Guide by Jerry Dorsman, Crown Publishing Group, 1998, ISBN: 0761515178
Under the Influence for Parents: The Truth about Kids, Alcohol, and Other Drugs, How to Recognize the Problem and What to Do about It by Katherine Ketcham,
Ballantine Books, 2003, ISBN: 034545734X

Where to get help

• Therapeutic Axis provides psychotherapy in Sydney for persons requiring assistance with addiction and substance abuse.
• Contact Us
• Mental Health Information Service, on 1300 794 991 or at www.mentalhealth.asn.au
• Alcohol and Drug Information Service can advise of treatment options in NSW, tel (02) 9361 8000 or 1800 422 599
• http://ndarc.med.unsw.edu.au/ndarc.nsf
• See your family doctor

Further information:
Australian Drug Foundation
http://www.adf.org.au/
NSW Health Department 2004 Drug Summit information
http://www.alcoholsummit.nsw.gov.au/fact_sheets
NSW Health Department
http://www.health.nsw.gov.au/public-health/dpb/publications/pdf/factsheets/alcohol.pdf
Alcohol Self Test
http://www.d12.com/Resources/Alcoholism%20Self-Test.htm
Alcoholics Anonymous
http://www.alcoholicsanonymous.org.au/info/anyone_new.php?nav=nc
http://www.helpguide.org/mental/alcohol_abuse_alcoholism_signs_effects_treatment.htm
Al-Anon – support for families
http://www.al-anon.alateen.org/australia/
Drinking Alcohol; How Much Is Healthy? NSW Health
http://www.mhcs.health.nsw.gov.au/health-public-affairs/mhcs/publications/5375.html
http://www.aona.co.uk/addiction/alcohol/causes-of-addiction
http://www.patient.co.uk/showdoc/27000488/
http://www.schizophrenia.com/family/dualdiag.html
Narcotics Anonymous
http://www.naoz.org.au/community/index.php
http://www.helpguide.org/mental/drug_abuse_addiction_rehab_treatment.htm
Family Drug Support
http://www.fds.org.au/

References:
Mental Health Association of NSW Inc
www.mentalhealth.asn.au