Alcohol & Addiction Medicine

An addiction is a condition in which a person engages in an activity where the rewarding effects provide a compelling incentive to repeatedly pursue the behaviour despite detrimental consequences.

Given the right (or wrong) circumstances, anyone can develop an addiction – to alcohol, to medications & drugs, and to certain behaviours. Whilst the cause of addiction is multi-faceted, no one ever sets out to become addicted to anything. Attributing blame is unhelpful.

These behaviours can range from gambling, the use of social media, accessing pornography, shopping, online gaming, food and even sex. A hallmark of an addiction is a compulsion or craving to continue with the behaviour despite negative consequences such as financial (especially with gambling), relationships, physical and mental health issues.

Although all addictions have the capacity to induce feelings of hopelessness, failure, shame and guilt, the longer-term outlook is much more positive with recovery expected rather than being the exception. There are many routes to recovery. One of the most important steps is acknowledging that there is a problem and then seeking help. Our GPs at Royal Park Medical are well placed and experienced to help in a non-judgemental and supportive manner.

The 2016 National Drug Strategy Household Survey found that alcohol is the most widely used recreational drug in Australia, with 85.5% of Australians aged 14 years and over having drunk alcohol one or more times in their lives. While risky drinking on a single occasion was more common among younger drinkers, daily drinking was more common among those aged 40 years and older.

The Australian Alcohol Guidelines refer to drinking which is considered low risk.

• For short-term drinking, limiting oneself to no more than 4 standard drinks is considered low risk for alcohol-related injury.
• For long-term risk, limiting daily drinking to no more than 2 standard alcoholic drinks is considered low risk for the development of significant alcohol-related problems.
• For children, and women who are pregnant or breastfeeding, the safest thing to do is NOT to drink, as alcohol (at variable doses) can be toxic to the developing brain.

Many adults can enjoy alcohol safely. For others – alcohol when in excess, can contribute to social problems (both with intimate and interpersonal relationships), occupational problems such as safety and absenteeism and legal issues such as drink driving. Health conditions can also arise from excess intake including certain cancers, intestinal disorders and skin disorders to name a few. Some people can become dependent to alcohol, making it very difficult to stop.

For more information of low risk drinking: www.alcohol.gov.au/

For online support for yourself or family members: www.hellosundaymorning.org/

Dr Paul Grinzi is one of Royal Park Medical’s experienced GPs who can assist patients with their alcohol intake and related problems, including alcohol dependence and detoxification.

Amphetamines are a class of (mostly illegal) drugs that are known as stimulants – the effects can vary enormously from a feeling of wellbeing and increased attentiveness and energy, through to feeling paranoid, aggressive or hostile. There are different forms of methamphetamine, generally distinguished by their appearance and perceived purity. The three main forms are:

• crystalline (ice, crystal, ‘meth’)
• powder (speed)
• base

People who use methamphetamine typically inject or smoke the drug, and often develop a dependence to this potent drug. The harms range from the risks of intravenous injecting, to mental health issues, dangerous driving, risks to the heart, to problems during a ‘come down’. This is where the effects wear off (usually 1 to 3 days after) and symptoms can include depression, paranoia, difficulty sleeping and headaches.

For more information about amphetamines, including treatment options: https://adf.org.au/programs/breaking-the-ice/

Benzodiazepines are a group of medications that are sometimes prescribed for problems such as anxiety and insomnia, although for these conditions they are no longer considered first line treatment options.  They can also be prescribed for epilepsy, alcohol withdrawal, and agitation in severe psychiatric disorders. Examples of benzodiazepines include diazepam (Valium), temazepam, clonazepam and midazolam. Because there is a high risk of dependence, benzodiazepines are usually prescribed for short-term use only. Alarmingly, benzodiazepines are used illegally as recreational drugs, by about 4.7% of Australians.

This class of medication is known as a depressant – that is they slow down the brain’s functioning. This can impair clear thinking and reflexes and may impair someone’s ability to drive safely. They also contribute to falls and unintended overdoses (often in combination with opioid pain medications).

People who have been regularly taking benzodiazepines often find them difficult to reduce or stop, and may find withdrawal symptoms very uncomfortable. At Royal Park Medical, we have experience in assessing and assisting patients slowly withdraw off these medications, often many years after their therapeutic benefit wore off.  Speak to our staff to direct to you appropriate doctors with this clinical experience.

More information about these medications and their effects can be found at: www.reconnexion.org.au/benzodiazepines-tranquillisers-and-sleeping-pills/w1/i1023210/

Cannabis is the most commonly used illegal drug in Australia. It looks like dried herbal material and can be green or brown in colour. It is made from the dried parts of a plant called Cannabis Sativa and has multiple alternate names such as bud, choof, dope, ganja, grass, hash, marijuana, Mary-Jane, mull, pot, wacky weed, weed and yarndi. Cannabis is usually smoked in hand-rolled cigarettes called joints, or in water pipes called bongs. Sometimes it is mixed into food, such as cakes and cookies, and eaten.

The effects of cannabis, like many drugs, depends on factors such as how much and how often you take it, the cannabis’ strength, how it’s taken (joint, bong, food), your mood, your experience with cannabis and whether cannabis is taken with other drugs, such as alcohol.

The immediate effects vary: from feeling happy, talkative and less self-conscious than usual, to feeling sleepy, nauseous and uncoordinated. Some people may experience paranoia; feeling anxious, nervous or afraid after using cannabis. Longer term use can lead to lung diseases, low motivation and in at-risk individuals, affect their mental health.

It’s a myth that one cannot get addicted to cannabis. Whilst most people use cannabis irregularly and aren’t dependent on it, in Australia approximately 1 in 10 cannabis users are addicted, or dependent, on it, needing to continue their use to feel ‘normal’.

If you think you, or a friend, might have a problem with cannabis and need help, check out Cannabis Support (https://cannabissupport.com.au), or see your GP for assistance.

People who inject drugs (PWID) do so for a number of reasons. Many have developed a substance use disorder to drugs such as opioids, benzodiazepines and amphetamines, as well as other drugs.

One serious risk with injecting drugs is the significantly increased risk of an accidental fatal overdose. Scriptwise (www.scriptwise.org.au) and Cope Australia (www.copeaustralia.com.au) have information on detecting and treating a drug overdose. If you, or someone you know, would like to discuss overdose prevention, or a prescription for naloxone, please see us at Royal Park Medical.

Sharing injecting equipment with others is a real concern. This includes needles, syringes, spoons and tourniquets. A microscopic amount of blood is all that’s required to potentially transmit serious infections (like Hepatitis viruses and HIV) from one individual to another.

At Royal Park Medical, we are experienced in assessing for, testing and treating Hepatitis C, often without the need to refer our patients to a hospital or specialist. Dr Grinzi has completed training as an S100 Hepatitis C prescriber. High risk patients such at those who inject drugs are able to access free Hepatitis A and B vaccination through our clinic.

For information regarding safer infecting practices: http://www.penington.org.au/wp-content/uploads/2017/05/NSP-clients-new-injecting-equipment.pdf

Opioids are a class of drugs that include certain pain prescription medications (codeine, morphine, oxycodone, fentanyl and many others) as well as the illegal drug, heroin.

Opioid pain medications are used for the treatment of severe pain relating to surgery, end-of-life care and certain short-term painful conditions (eg severe trauma). There are best reserved for short term use (eg a few days) for most conditions. The evidence for continuous use is poor, with some emerging research demonstrating that opioids used for greater than twelve months may make pain worse and decrease overall daily function.

For some people, in addition to pain relief, they produce a euphoric feeling and can be misused. For others, regular continual use causes the body to become dependent on the opioid, making it difficult to stop or reduce.

If you have found yourself using an opioid medication for longer than originally intended, or struggle to cut down/stop, you may have become dependent on the medications. Some people develop a more serious complication of their opioid use called Opioid Use Disorder; this is where obtaining, using and recovering from the effects of the opioid start to impact on the day-to-day tasks of the person affected, potentially affecting relationships, work and recreational interest. Cravings for the opioid start to take over one’s thoughts, making it very difficult to stop.

Opioids are also potentially very dangerous, contributing to a large number of unintended overdose deaths in Australia, with prescription opioid overdoses exceeding heroin deaths. This risk is increased with higher doses and when using opioids in combination with other drugs such as alcohol and sedatives such as benzodiazepines.

Opioid Use Disorder can affect anyone taking opioids, whether they are prescription medications or heroin. Thankfully, there is very good treatment for this serious condition – medication-assisted treatment of opioid dependence. At Royal Park Medical, we offer treatment for Opioid Use Disorder, through Dr Paul Grinzi who is a fully accredited Buprenorphine/Naloxone and Methadone S100 prescriber. He brings a wealth of experience in this area and treats his patients without judgement or stigma. The recovery from a condition such as Opioid Use Disorder is made easily with a supportive, understanding GP by one’s side.

For further information:

Brainman series of videos about pain and opioids:
https://www.youtube.com/watch?v=5KrUL8tOaQs  https://www.youtube.com/watch?v=jIwn9rC3rOI
https://www.youtube.com/watch?v=MI1myFQPdCE

Information about codeine containing pain medications: http://www.scriptwise.org.au/codeine/community_toolkit/

Information about reducing the risk of opioid overdose prevention:
http://www.penington.org.au/programs-and-campaigns/resources/cope-overdose-first-aid/

Tobacco, the main ingredient in cigarettes comes from the dried leaves of the tobacco plant. It contains nicotine, a highly addictive substance, as well as a number of other chemicals, many of which are cancer-inducing and harmful.

Unlike alcohol and many other drugs, there is no safe (or low risk) of tobacco use. Thankfully, the rate of smoking in Australia has been steadily decreasing over a number of years, in parallel with greater awareness of the health risks, increased cost and decreased social acceptance of smoking.

Quitting smoking is extremely important for the health of anyone who is smoking. At Royal Park Medical, we understand that this can be difficult and we offer a comprehensive assessment and treatment process to assist our patients to quit and stay quit.

Whilst the majority of people who have quit smoking, have done so by just stopping (’cold turkey’), the success rate of quitting improves significantly with the help of your GP who may consider nicotine-replacement therapy, other prescription medications alongside some behaviour and thinking strategies. If you are thinking about your smoking, please seek help and book in to see your GP.

The Quitline has some excellent resources relating to quitting smoking: www.quit.org.au

This information is intended to support, not replace, discussion with your doctor or healthcare professional. The authors have made considerable effort to ensure the information is accurate, up to date and easy to understand. Royal Park Medical accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen.