Alcohol and Depression - Dr. Conor Farren 2013

good evening I think we're all set I have my computer you've the slides the microphone is working what can go wrong what I'd like to do to talk about tonight is I have a few things I'd like to say I'd like to talk a little bit about alcohol I'd like to talk about a little bit about depression and I'd like to present you some of the research that we've been conducting here I'm going to apologize if some of you have heard me speak before because you will probably find a certain amount of this repetitious because I tend to too to repeat myself but I'd be very happy to take questions at any stage but preferably at the end but if you if you feel the urge and there's something that has to be said go go right ahead I can I can handle the flow but I be I hope to speak for about 30-40 minutes 45 minutes and then maybe take about 15 minutes and questions something along those lines I'd like to present a little bit about alcohol first and alcohol as you know it's been with us for a while it wasn't the Irish who invented alcohol Euripides a Greek in 400 BC which is a while ago now they talked about Bacchus discovering the juice of the grape and introducing it to mankind stealing their by each grief that mortals suffer from well that was an interesting view and that was held 2500 years ago I'm not quite sure I'd agree with that but this is a painting by the Spanish painter Velazquez about the wonders of Bacchus discovering the grape and the joys of drinking however in more recent times we've discovered that there are some negative aspects of alcohol and this is just some of the lists of hundreds of famous people who have developed addiction problems Amy Winehouse tragically died about a year and a half ago at the age of 27 with a severe alcohol problem Beethoven was actually a well known heavy drinker and I don't think it contributed to his deafness I don't know if a contributor was know simply but I think it contributed to his relatively early demise but so he will he I don't think the term alcoholic was invented around the time of his life but he certainly was a very heavy drinker Billy Joel as a reformed alcoholic and was drinking during a lawful out of this musical career that next picture is of anybody identified who that it is it is actually Britney Spears and that's injuring her one of her less productive periods and when she was caught intoxicated that's buzz' aldrin it was number two on the moon and Buzz Aldrin was was an alcoholic and has talked about his is entering into recovery it is said that he was actually the first choice to to be the first man on the Moon but the rather dour and less charismatic number one again was switched at the last moment so actually and and it is thought that it partly it was recognized that buzz had a bit more yah-hoo a little bored jazz about him and that it was thought that Neil Armstrong was a more stable more cam character and being the son of an accountant he he kept that rather terror of Las Vega and but was Alton turned out to be number two and he was a reformed alcoholic Charlie Sheen has had multiple episodes of the public intoxication and troubles and I don't think he's in recovery he is evidence of the genetic nature his dad Charlie Sheen was also an alcoholic and is in recovery Robert Downey jr. has had very public battles with a addiction with alcohol and with heroin and had a 10-15 years saga of addictive disorder but he's currently thriving and doing very well in recovery and then our own George best had a long untroubled battle with alcohol received a liver transplant was did absolutely wonderfully for a year after his liver transplant and then on the first anniversary of his liver transplant he decided to celebrate his his his successful recovery for a year and the liver transplant started rinky again and was dead within six months but they're just a random sample I could go on there are hundreds of other examples of a famous alcoholics are basically demonstrating the point they're everywhere then it's not them it's it's it's it's so common the Irish artist Michael Farrell was also an extremely happy drinker and I'm now garlic he died about 12 years ago and he this is one of his drawings or his paintings and this is obviously on the theme of drinking and glass and as a self-portrait of him in relation to alcohol in terms of depression again the list of celebrity who have had depressive disorders or variations of is extraordinarily common sinead o'connor's had public battles with mood disorders Elton John has been public about his his problems with depression and also work with addiction Robbie Williams has also had severe bouts of depression and gone public about them Stephen Fry as battled depression and bipolar disorder Winston Churchill famously talked about his black dog and then Hugh Laurie Stephen Fry's previous comedy partner has also publicly talked a lot about his battles with depression and again the list goes on and on and this is only a small selection of those who have gone public about it again this is an extraordinary common problem the famous artist Jack Yates also suffered severely from depression and this is one of his later paintings in which there is a very morbid and a clearly depressive theme on evidence and it had a massive influence upon his his painting and his artistry and he battled depression until until until his death alcohol is the most troublesome drug that is known to man and this is a producing a slide here from research produced by David Nutt who's the leading pharmacologist in in the UK concerned with drugs and alcohol and this is an expert analysis of the comparison between all other drugs of abuse and an alcohol in terms of harm to self and harm to others and that while other drugs such as heroin and cocaine may have caused a significant potential harm to the the the user it's only alcohol that has there an equally high potency at causing destruction to the user and destruction to those around them so alcohol has that unique characteristic of as a potential substance of abuse of being the most harmful substance known to man in Ireland we drink a lot we are still the fourth highest in the EU about 11 liters it's conduct about about 10 recently where the highest binge drinkers in Europe about 34% much higher than the EU average with a massive increase in consumption during the Celtic Tiger years up to 2005 and it's tapered off a little bit since then we're still very high but we're not quite as high as we were in 2005 the this has produced a massive increase in alcohol-related deaths where in that same 10-year period up to 2005 there was a hundred percent increase alcoholic liver disease by increased by 150 percent and a 90 percent increase in alcohol-related injuries over that same 10-year period so not only have we had an increase in alcohol consumption we have had an increase in the consequences of that and basically it says that alcohol consumption and our relationship at alcohol is is decidedly harmful what happens if we become problem and we do nothing about it the prognosis is not good 40% of people who develop problems or an addiction to alcohol drink themselves to death 35% go in and out of drink problems over the lifetime and 20% stop spontaneously alcohol dependence takes 10 years approximately of an individual's lifespan it is slightly less harmful than smoking but just slightly less so it is up there and it is a massive negative health consequence I'm going to give you a definition of how we define a problem with alcohol in about a month's time the terminology is going to change from alcohol dependence to a thing called alcohol use disorder so I thought rather than go with the Peris we'll go with that the terminology that is developing and I'll give you a little bit of background of that when the term alcohol dependence was developed it was developed to convey the problem that it's not just an alcoholic it's not just an all-or-nothing it's a syndrome it's a cluster of different characteristics and there was a definition of alcohol abuse and alcohol dependence and then over the years has become clear that really alcohol abuse and alcohol dependence are the same thing so the experts in the u.s. have decided to mal gamate the two and cold alcohol use disorder and the definitions of how you look at a problem with alcohol or alcohol use disorder are really done by all sorts of different characteristics and it's according to eleven major headings the first that alcohol is an important or essential or takes a lot of time in an individual's life that alcohol is major rule harm in that person's life perhaps in the role as a parent or spouse or or as a breadwinner important social recreational activities are given up because of alcohol that the individual stopped and started consumption in the past cut down for a while gone by Konnor there's an effort at cutting down on on a regular basis the individual generally drinks more than they want to when they have a drink so there was a momentum B I'm drinking difficult to stop when they get going they keep on drinking despite awareness of recurrent problems so persistence despite harm and the individual drinks in hazardous situations classically drink driving there may be significant craving so a strong urge to drink at times and then there may be signs of physical addiction to alcohol which a lot of people believe are the only signs of a problem with alcohol withdrawal symptoms signs anxiety shakes sweats nausea or agitation and stopping alcohol and there may be an increased tolerance to alcohol over the years it takes more to get me drunk than it done than 10 years ago now the interesting thing I've given you 11 headings in order to make a criteria of alcohol use disorder you just need to okay not all eleven okay and then in order to be considered severe alcohol use disorder four okay so this is not an issue in which it is oh you have to have everything you have to have lost house wife family kids and job in order to have defined as a problem that's a critical issue because very often when someone is looking at themselves or may have issues but you know I'm not as bad as X over there because they've lost their job they've lost their house it lost their wife and so on so I know I may have issues but I'm not as bad as X but that's not the defining characteristic it is it is any essentially two of the above headings and that's an important point to the other point important but it's not quantity driven it's not that I have two pints a night I don't have a problem you three you do and this is not it's a relationship issue this is how this this this substance affects my life and that is the the most important criteria that were looking at the line in the sand is there a problem is there not a problem what I'm going to be talking about in this presentation is one aspect to dual diagnosis but when you look at it jewel diagnosis is a massive topic we can look at other substance abuse alcohol marijuana code ketamine's LSD ecstasy opiates so there's a whole series of potential substance abuse and then in terms of the range of psychological or psychiatric issues that can be psychotic problems bipolar problems depressive disorder anxiety disorders cognitive concentration problems or personality disorders and really this presentation is only going to focus on one of the interactions between psychology psychiatry and substances of abuse but you can see that this is a highly complex matrix and so while there's variations of a theme in each of these addictive disorders and relationship each of the psychiatric ones clearly it's a massively complex area and of necessity tonight I'm only going to really be talking about one of those areas so let's look at the interaction between mood and drinking okay about 6% of the population suffers from alcohol dependence to use the other terminology and then by 6 and 7 that's about 10 12 percent suffer from from alcohol use issues at any one time and then a further 8 percent would be in the the issue of heavy consumption but not quite problematic about 8% of the population currently suffer from a depressive disorder and 1 to 2 percent from a bipolar so about 4% of the population 2 to 4 percent suffer from bought an alcohol and a mood problem when you take it at a at an epidemiological level this is backed up by research and is these are two studies are going to present not because they want to give you the detail but just to show that there's two major studies in one large study done in the US with a lifetime linson of alcohol dependence those 12% and increased depressive disorder on an are about 2 to 1 if you had an alcohol problem you're twice as likely to have a depressive problem than if you didn't have an alcohol problem and secondly a study of a couple of thousand people with alcohol problem alcohol dependence subjects in a genetic study called the Koga study it was also done in the States and I'm going to bring it down to the second last of the third last point the lifetime rates of independent mudras disorder is raised mildly in bipolar situation it was considerably higher and this was also reflected in close relatives suggestions there's a genetic component to this these these findings only giving is I've replicated very frequently around basically alcohol and depression go together and once a hand and glove but say and in D fingered glove or just right there's an association there what are the mood effects of alcohol the initial mood effects are fairly straightforward intoxication we've all had the experience generally a pleasant alteration of mood and often a diminution in anxiety symptoms depression caused by alcohol can because can arise hours later it can cause the next day or can occur a few days later you can get drunk on Friday and get depressed on Tuesday okay that can be that delay and the reason I know is because none of people have told me over the years and while initially I wouldn't have believed that and I've heard it so often I now believe it is that it's it's not just that evening or the next morning where you might say there's an immediate effect but there can be a delayed effect in which alcohol consumption of heavy out that consumption produces a mood effect a number of days later for some alcoholics it takes a certain amount of alcohol depressed to pints fine for pints get depressed okay for some they only get depressed on one occasion out of one out of five or ten or twenty so that can go drinking three at weekends out of four in a month and fine and then on the fourth weekend suddenly the mood goes down okay so there is that variable interaction the variable response and it can be significantly dependent on the overall mood before drinking you go out and you're in good form don't get depressed you're mildly depressed you go drinking and then that mild depression is magnified tremendously by the alcohol okay so it is an enormous variation both within the individual in relation to quantity and and a timer and which the the mood effects about the but they are very very big column alcohol can bring on suicidal ideas okay it can make suicide ideas more intense and most distressing of all it can make someone disinhibited enough to try out suicidal activity which they wouldn't do and sober so when we think of being drunk and disinhibited you think if you know shouting them running up and down the middle of a high stranger or whatever I'm making noise and that's what most people a lot of people do when intoxicated but if you're depressed and disinhibited and you're suicidal and disinhibited you can act on a suicidal idea that you wouldn't do in sober and that is an extremely distressing factor when someone comes in here with an alcohol problem 40% have major depression 50% of anxiety and about 15% of symptoms of elation or mania yeah after four weeks is surprising the instance of depression goes down from 40 percent to 10 percent the instead of anxiety goes down from 50 to 15% and the elation the mania goes down from 15 to 5% so clearly abstinence a number of weeks of abstinence often a number of days but a number of weeks of absence kind of a massive positive mood beneficial effect theoretically you wait for weeks to be absolutely sure but generally after a week 10 days you can really should get an idea if an alcohol mood issue is is is is essentially what's a cure but but got rid of through through through sheer abstinence so this is really important 25 percent of suicides in this country are solely attributed to alcohol alcohol is present in 58 percent of completed suicides the international norm is 38 percent so in Ireland we've a really particular problem with alcohol and suicide if you commit suicide and you're Ondra 30 in this country you're 93 percent have alcohol on board when they actually take their own lives so this is a worldwide funnel that is particularly strong in Ireland and is particularly strong in young people in Ireland an alcohol is present 41% of deliberate self-harm that means suicidal gesture but not actual completed episodes and I produced this graph from statistics between 1970 and 2000 about the rise in an alcohol consumption and the rise in the suicide rate and you don't have to be a statistical genius to see that there is a connection there's a very strong correlation and this goes as far as 2005 I since 2005 the alcohol consumption in the country is tapered off slightly and the alcohol but the the suicide rate has indeed gone up so what has happened particularly in the last four years is that the suicide rate has gone up because of the economic situation and the recession and that effect and not because of other of alcohol so I'm certainly not turning around and saying it's all due to alcohol but there is a massive connection between the two particularly as the rise in alcohol consumption until about 2005 so bring thoughts I'm not going to go through all the factors about depression because that would take many hours days weeks so I'm just going to pick few factors that I think are of interest that I think of importance then you may not be aware there is a risk for depression and I want to just explore that family history depression of azor disorders about 40 percent genetic okay which means that a large number of people who get episodes of significant clinical depression do have a family history alcohol is about 50 percent genetic but what a RHIB depression is about 40 percent genetic women get depression more often than men do and that's it's a ratio of about two to one traumatic life events particularly recent life events if you've had a particularly stressful a traumatic life event in the previous six months you were more likely to get depressed than if you haven't child birth is a major cause of depression and postnatal depression as it being frequently talked about and wonderfully talked about by some celebrities but it is a around 10% go get episodes not just of baby blues which is about 40 50 % but about 10% good full episode of depression post childbirth early childhood neglect or abuse or loss if you lose a parent before the age of 11 if you suffer trauma suffered any sort of abuse physical neglectful sexual all this severe childhood trauma lens the increases that the risk of later onset of depression personality traits some people who are on the bitumen the obsessive neat punctual rigid side tend to get episodes of depression rather than those who are on the more casual relaxed the eye wants a sloppy side because I but certainly the more relaxed child and then again that makes intuitive sense personal isolation human interaction tends to diminish episodes of depression isolation tends to increase it so that's a an association alcohol and substance abuse and physical disorders flu thyroid disorder cancer loads of different stroke heart attacks lots of physical illnesses are associated with the onset of depression later when someone is drinking to achieve sobriety they can also get depressed after having achieve sobriety which is a tremendous distress if you put all the effort into recovery you've achieved a degree of sobriety or engaging in recovery and then your reward is you get about a depression and and that seems like a terrible reward but that can occur alcohol withdrawal can produce anxiety symptoms craving for alcohol can present as depression some people can miss alcohol and a message and a convertible can be a form of craving and representers depression coping with the effects of a long period of drinking when people are doing they often of neglectful of financial matters relationship matters were problems and awful in early recovery and early sobriety all these financial and work and relationship issues come home to roost and have to be dealt with so that can produce a significant degree of depression and indeed when someone is drinking really maturity people aren't maturing developing coping skills when they're drinking so unfortunately if someone's been drinking for many years they really are dealing with coping skills that are 5 or 10 or 15 years out of date so often there's a degree of maturity required which is suddenly thrust on someone in early recovery and it's it's a big learning curve I'm going to talk a little bit about the treatments of depression and because I think it's important to be aware about the breadth of this ok this is not the most familiar treatments that you'll hear talking about it by doctor since the guides will often be medications such as antidepressants and mood stabilizers which can be used for bipolar disorder also can be used in in instances as a booster for antidepressants and rarely can be used on their own for treatment of pure depression but mood stabilizers are increasingly being used as boosters or as as for depression as well psychotherapy is is a wonderful way of helping with depression it can be any one of a variety of different types of therapy I mentioned cognitive therapy interpersonal therapy and psychoanalysis the whole range of psychotherapists can be wonderfully helpful not for everybody not in all situations so there are there articles which also detailed there can be negative aspects of psychotherapy but by and large psychotherapy talk therapy getting it out of the system can be wonderfully helpful in terms of taking the edge off depression self-help books I'm going to talk about my own book in a just a minute groups such as it this one aware grow recovery fabulous forums educational forum supportive forums and and that that can be wonderfully helpful in terms of other coping with depression exercise research is being done a lot about exercise and depression and mood disorders and what seems to be clear is that robust cardiovascular exercise can be very helpful not gentle exercising not walk in the Chihuahua for 10 minutes but actually cardiovascular exercise it means getting out there jogging running cycling gym that level of exercise I one very well done researcher talked about forty five minutes three times a week of sweat and juicing exercise can actually be very helpful in moderate anxiety moderate depression maybe not quite as helpful in the severe side but certainly another that mild moderate levels can be really really helpful relaxation we hear an awful lot I read an awful lot about mindfulness mindfulness meditation yoga tai chi deep relaxation can be wonderfully helpful particularly for anxiety but also for depression and so I would it's important when looking at depression is looking at the breath and not just the single oh we double the medication it's a whole breadth of treatments that should be looked at in terms of treatment and I mention ECT for severe depression resistant depression or very very life threatening depression it's important that is a highly successful treatment which can be used and is indeed remarkably successful I wrote a book which of about two months ago call the you turn a guy to happiness and this book is based on somewhat of a cognitive model about looking at the factors that contribute to to various negative emotions including depression anxiety and looking at factors that that that an individual can can look at in order to try and help themselves deal with it it's it's under a number of headings exploring the concept of self understanding which isn't always dealt with in all forums looking at negative emotions how they hurt us anger jealousy depression looking at the experience and how to escape the experience looking at fear and an interpersonal criticism looking at probably the one of the most important things self belief and the feelings of inferiority self esteem is a really important concept and most people who have gone through an episode of depression would would would would recognize that how it can be a very self attacking series of thoughts so exploring that and looking at the fundamentals of self belief and changing around a personal self images is really important in terms of long-term getting rid of negative emotions looking at the concerts of personality and how to project a personality and inter personal relationships and the importance of talking communication getting things out of the system then a little bit of the importance in relationships and then at the end of all looking at the the purpose is that there's no point in going through a tremendously negative experience without children well what use of where where can I go with this how can I turn this around so looking at how to explore a joy and discovering a purpose in life as part of writing it I had to come up with a slightly weird culture what's the concept of happiness how how do you define happiness is it just an absence of depression and acts of anxiety and absence of unhappiness I don't think so and I believe that happiness is a rounded Lea content into a very coherent unified positive mental state it's not an ignorant superficial cheerfulness it's not the Eternal Sunshine of the spotless mind is not glib self-insurance and an ignorant wing it's a knowing contentedness and I believe that is a it's a lot more than just an absence of depression so part of my reason and write in the book was to look at the idea of think this is worthy of attainment there's absolutely no reason why we can't attain that and there's absolutely no reason that we can't go on a journey to happiness part of what I also have done here has been looking at the the treatment of alcohol and the treatment of depression together and ten years ago I developed the dual diagnosis program here and it's a broad program it looks at lectures looking at both general issues and specific issues video sessions specific for the program individual therapy sessions alcohol anonymous jewel recovery groups life ring support groups and then group treatments various headings that are take part as part of the program there's an initial part of the program which is an assessment detoxification a full program which can last up to four weeks and then an aftercare of up to a number of months up to six months suppose discharge it was developed with eight principles in mind its develop saying well how do we take those principles how do we put them into practice the importance of follow-up and I'm going to present some of the research that looks at how important follow-up is essentially the real program the real therapy the real treatment starts the day someone leaves rather than not just what happens in the program we emphasize the interrelationship of the diagnosis which is follows on from what I was saying earlier is that there is such a connection between alcohol and depression and when are both are present you really can't improve on one without improving in the other both of to be tackled with the particular therapeutic modality relapse prevention is the particular addiction therapy modality that we emphasize we emphasize education lectures videos and discussions we also emphasize the stabilization of withdrawal and mood so if medications require detoxification medication antidepressant medication mood-stabilizing medication we use it okay we talked about the individuality of the program not there nobody is another program as in exactly the same circumstance so we adopt the program to the individual while still completing the program we emphasize both equivalently and we talk about empowerment individual responsibility it's someone's journey it's not that the doctors or the therapists journey the research program we conducted we started about seven years ago eight years ago we did a baseline series and assessments we did a whole series of depression anxiety elation and craving measurements three months six months and two years post discharge although I'll be presenting some of the two-year factors we're now doing a full analysis of a five-year five year data but I don't have a haven't adequately refined for presentation we did blood tests and we did essentially follow the gods of two hundred people and we got about 75% of them at two years out of the twenty five percent some died some refused to participate some illness and some where were uncontacted all the program is essentially divided between those who depressive disorder and a bipolar disorder all of alcohol dependence there averaged around in the mid 40s 14 years of education most were in for 3035 and on the bipolar side slightly longer stay most of one or two admissions previously a strong family history both of alcohol problems and of psychiatric problems and indeed a suicide attempt in the previous year about 30% so these people who had significant issues we in terms of analyzing as we we looked at age gender and diagnosis as being very important factors and I'm not going to go through the numbers but basically that we broke the the group up into three age groups below 30 31 to 50s being middle-aged and much to my distress my statistician said that those are we were regarded in the elderly group so having just recently recently reached that I was I was very distressed too but that's what my statistician insisted so so 50 is now elderly and then we dip read and divide people according to depression and bipolar and under and according to gender what was clear is that people by and large did well and they often did well initially based at baseline that the depressive disorder measurement failed significantly and it was remained at that level in both the depressed and the bipolar group at two years and indeed I can let you know at five years that was that the same findings for anxiety this is my SIA tea scale it was high at baseline a discharge of his lower and then at six months and in two years it was into the very low level these are biological markers of alcohol consumption and they fell at baseline in six months and but this is the bit most particularly strong blood measurement of alcohol consumption and that fell at baseline at six months and had fallen by two years and then the self-report of alcohol consumption which is another scientific way of which we basically asked how much did you actually drink recently very high at baseline not surprisingly low at six months of one year and two years considerably lower so the number of drinking days that they had in the previous 30 or 90 days was much lower and the number of drinks per drinking day also went down very significantly at six months and indeed as far as the two years I'm going to give some figures as to many figures there but I'm just going to just translate some of that in the depressed group the number of drinking days at baseline was forty the number are two years both drinking days in the previous 90 have gone down to five so percentage completely abstinent was almost 60 percent in the depressive group and was 53 percent in the bipolar group so basically a lot of people had done very well and if they were drinking the number of drinks they were consuming was much much less we tried to say well how do we found out a base and what predicts who's going to do well organized aftercare and discharge those that said you know what I'm going to go to the aftercare very significant predictor of three months that that was a very protective factor if you had a high anxiety on admission that was a prediction of relapse those that were more anxious did worse and the audit score was a score of alcohol severity I'm not if you're a higher degree of alcohol severity in this particular scale that was predictive other issues family psychiatric history depression score were not predictive by six months slightly the day the same aftercare organizing applica was still statistically significant but anxiety had faded the the the audit score the alcohol budget will was still predictive family psychiatric history it kind of was predictive and drug history those who are a drug history essentially did worse so there's a slightly different set of factors at six months at two years some other differences emerged gender emerged by and large women did better and not massively but significantly and so men were were more non absent than women at two years once more reflecting average that women are much more superior to men and that's that's that's something which we all have to acknowledge diagnosis that those who had a depressive disorder were were more likely to be non absent and those who the bipolar disorder slight increase slight relative increase but a statistical relative increase relative the depressed those who have bipolar tended to drink just a little bit more age basically those that were under thirty did badly okay that matches international literature which says that young people have a tremendous difficulty in coming to terms with any addictive disorder this is a dual population but young people have a tremendous difficulty in in coming to terms with our numbers of young people were not massive relative to the middle aged and the so called elderly and but you can see the massive difference between 86% non abstinent and in the older group 39% non-abstract so you can see there's a big difference there young people the real issue there is young people have a difficulty in dealing with addictive disorders and then after care attendants those that attended aftercare tended to be more not absent than than those who didn't in other words after care was protective okay which is match what we found at six months in the three months those who were earlier absent those who were abstinent earlier tend to do better than those who relapsed earlier and that's you might say is a statement of the obvious but it's important is that if you're absent at three months you're more likely to be absolute later and if you're absent at six months you're you're more likely to be absent at two years so those that stayed well initially tended to stay well into the into the long term so the conclusions we arrived at this is a large complex and undertreated area that this triple integration of inpatient and outpatient medication and therapy addiction and mental health disorders this is a program that can be successful that bipolar people people with a bipolar disorder and a depressed resort can be treated very well together baseline predictive factors such as low anxiety low audit scores and good aftercare can predict good medium term outcomes and then followed a two years with a female gender older age a depression rather than a bipolar diagnosis and good earlier absence all predicted positive two-year outcomes so two two years ago I published this book overcoming alcohol mices which details an awful lot of that the the treatments that are available for the treatment of alcohol problems and the various treatment approaches and an outline at different ways and some of which have mentioned two tonight about the treatment of alcohol disorders and I was delighted to say the Mihrimah caliber was launched for for me and I think it's a nice way that her picture is up there to finish this lecture because I think how else could we finish a lecture in a nicer way so thank you very much

Channel: Aware

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Keywords: Aware, Alcohol, AUD, Depression, Stress, Anxiety, Treatment, Dr. Connor Farren

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Length: 41min 6sec (2466 seconds)

Published: Wed May 15 2013