USW Research | Alcohol Related Brain Damage - Addictions Research Group

hello everyone welcome to this roundtable discussion regarding alcohol related brain damage my name is ruth northway and i'm going to be sharing this discussion i'm professor of learning disability nursing at the university of south wales um and here in my capacity is faculty head of research before we start on the questions i'm going to go around the panel and ask if they can briefly introduce themselves so if i can hand over to bev hi ruth yes i'm bev john i'm professor of addictions at the university of south wales and i co-lead the addictions research group thanks bev julia hi i'm julia lewis i'm a consultant addiction psychiatrist with the an iron bourbon university health board and a visiting professor at the university of south wales thank you andrew i'm andrew meisel director for wales at the charity um alcohol change uk and i've been working in the substance misuse field probably for the last 10 or 12 years thank you andrew gareth thanks ruth i'm uh gareth rodrick davis i'm professor of psychology at the university of south wales and i co-lead the addictions research group with bev thanks gareth rahman hi i'm raman sakhuja i'm a consultant psychiatrist and also a visiting professor with the university of south wales and have a special interest in neuropsychiatry specifically brain injuries traumatic or non-traumatic and their consequences thanks everyone just by way of setting the scene i just wonder if perhaps first of all um gareth can you tell us a little bit about what alcohol-related brain damage is uh yeah um alcohol-related brain damage is a it's a complex set of conditions which involve structural and functional changes to the brain as as a consequence of long-term excessive alcohol use and it can be thought of as a spectrum of disorders starting at the more mild end with um mild cognitive problems progressing through to more severe problems such as alcohol alcohol related dementia and then also other problems which are not necessarily related to the direct neurotoxic effects of alcohol itself but more related to things like vitamin deficiencies so there are disorders such as pellagra and also corsica syndrome which are far more severe disorders and can exhibit as severe cognitive problems severe memory problems and such as confabulation for example where an individual may have confused memories where they fill the gap with almost created or imaginary memories so it's thought of as a spectrum of conditions related to long-term and excessive alcohol consumption okay one of the words that you use there which i think people probably might want a bit of clarification about is what do we mean by this term excessive because i think probably people judge that in different ways bev i wonder whether you could say a little bit about that well it's uh yeah it's a very important point and so as we as most people probably know um the um public health guidance on um what are safe levels of drinking is up to 14 units a week and that is spread over the week with alcohol-free days during the week um the recent statistics in wales um show that around 18 of people self-reported um drinking more than that and people who drink a lot or drink more than the guidance um consume around two-thirds so around 70 of the alcohol that is consumed in wales so the sort of you can immediately see the sort of um you know it clusters a little bit um above above that um in terms of alcohol-related brain damage um what research suggests is that um to be sort of in the um at risk group if you like so to be drinking consuming alcohol at levels that put you at risk of developing alcohol related brain damage tends to be um around the levels of about 35 i mean approximately 35 units per week um and that's you know we do talk about chronic alcohol consumption so that's over a sustained period of time if you like so um you may say i don't know five years or more um i think an important point um when we think about units and you know what constitutes units of alcohol is that it's actually um often less than people think so 35 units of alcohol a week would be approximately you know give or take 15 pints of beer or lager and three and a half bottles of wine so when you think about it in those terms um this is not so you know we're not talking about something that is unique to sorts of people that some people would stereotype as very very high drinkers i think that's an important um you know consideration for everybody really people being at risk of this and i'm just wondering whether there's any particular groups of people who might be deemed to be at risk i'm just wondering andrew whether you would perhaps be able to comment on that i think historically we always assumed that alcohol related brain damage or vertical corsicoffs similar conditions like this but the sort of thing you'd expect to find in in street drink is probably the sort of the stereotype uh the people could imagine a you know an old man with a with a grubby beard carrying his life around in a shopping trolley and that cohort of of drinkers of heavy street drinkers who are often very undernourished and physiologically alcohol dependent and alcohol is is often their sort of their main source of energy as well uh they're obviously a very high risk group but interestingly what we've seen from a number of studies uh particularly from scotland i think is that um although you might expect to find the bulk of cases amongst amongst older men still we are seeing them in in younger people and when i say younger i don't mean very young like sort of teenagers and 20s more sort of 40s and 50s and also seeing them really across the the social spectrum amongst people who might consider themselves to be respectable professionals for wanting a better word so um although we a lot of the focus will be on the very obviously vulnerable drinkers um as with all drinking issues it certainly doesn't help to uh to stereotype too much i don't know whether can i just uh comment there as well you know i just picked up what and when bev was saying i think one other group that we sometimes forget is the pregnant women uh and we talk about arbd in its you know although it is an umbrella term most people will still think about arbd only in terms of the wernicke's and all the other rest of these syndromes seem to sort of be ignored but if they're not at the forefront so you know the brain injuries for example traumatic ones which are associated with alcohol that's one and pregnancy as i was talking earlier this uh you know there is no safe limit in pregnancy and they've been time and time over and over needs to be emphasized because now there's so many papers coming out in research which clearly tell us the incidence of autism adhd and neurodevelopmental problems that you know the children start developing in in who are exposed to alcohol in neutral so that's that's something to just bear in mind as well yeah i don't know whether julia whether you wanted to come in from a clinical perspective as well on that um yeah i mean we we are seeing um younger and younger people uh present with it i think my youngest was in the mid-30s um whereas the the majority i would say in the in the sort of 50 to 60 age range we do know from research that women tend to develop it earlier than men do so there's something particularly vulnerable about the female brain um and also um if you are of a higher intellectual capacity to start off with it's almost as if you've got you've got more brain reserve to lose before people start to notice that there are symptoms so that that's um becoming evident as well and and although we talk about the conditions the neurocognitive conditions that link to alcohol you can have more than one neurocognitive condition so that some people can have alzheimer's as well because they've got a family history of alzheimer's or you know you know other sorts of things so um very often when we do comes in people with alcohol related brain damage we find other things as well so the obviously those people are more vulnerable then to the effects of alcohol and i think that is julia what you said is critical because uh you know when you are seeing these patients and how these services are designed are such that they seem to be sort of mutually exclusive so if someone has an alcohol related brain damage almost feels as if they can't have alzheimer's or any other degenerative condition and it's just like oh it's alcohol over to cd80 only if it is dementia then we'll be interested and we need it all the time yeah i mean this is this is box yeah i mean this is this is one of the important issues and one of the reasons why i would use the word complex when rbd was and and you know the very issues that andrew julian and ramon have referred to make it difficult to even sort of pinpoint precisely what sort of prevalence we're talking about here because um there's a lot of confusion around what counts as arbd what an arb diagnosis is um and also the complexities of other disorders so you know in our own research we've tried to try and identify what the prevalence of the disorder is but we've really had to piece it together from other pieces of of information by directly talking to to services and service providers who come into contact with people at risk we've had to try and establish what sort of labels people are putting on the conditions that they're observing and whether that fits the the arbd definition so part of what we're talking about today and is the need to raise the awareness more generally to the conditions so that people can start to recognize that what they're perhaps labeling as something else fits under this umbrella definition it sounds as if i mean obviously it's a very diverse group of people potentially that this this particular label would it would apply to um but what would be obviously in common is the fact that everybody's drinking and drinking excessively over a long period of time so going back to the starting points i suppose why why do you think people turn to drink in the first place and i mean is it is it like other addictions does it progress in the same way i don't know whether either julia or rahman want to to comment on that i mean alcohol misuse is multifaceted um it's it's a legal substance so a lot of us have tried it um and and we will know that when you take it you you get a kind of a relaxation effect there is an immediate effect to taking alcohol so if you're someone who is quite anxious or who has um underlying horrible suppressed um or just you know struggles to deal with daily life you get introduced to alcohol which is virtually inevitable um and you find something that sorts it out for you and sort it out like that the problem is that the alcohol does a couple of things then first of all it stops working so you try and drink more when you don't drink it you get an effect that is actually the original symptoms in the first place but magnified so you keep drinking um and also it you know that as i say the great difficulty of it is that that it hijacks this natural system that we have in the brain for um motivating us to do the things that we need to do to survive so there's a set of pathways in your brain that make sure you eat and you drink and you procreate you do all those things that the species needs to survive and alcohol hijack said and alcohol says now i'm gonna make me the thing you need to survive and that is an incredibly powerful driving force for people yeah yeah which which i think you know as julia has very very eloquently put it uh i was thinking as he was talking of a traffic light system you know so there is a red button in the brain which is you know the front part of the brain in technical terms the prefrontal cortex which has that stop button so you and me maybe after having a few drinks know when to stop whereas in an addicted brain when it has become a chronic brain disorder that button is no longer operational and it's just go go the green light is just on so and it's sometimes easier for people to understand that if if they know that this red button is not there it's not a matter of choice for those individuals which very often people think oh why can't he or she just stop drinking well if it was that easy then we will not be sitting around on this table yeah i know what you're saying though it sounds as if it's it could be quite difficult that process going on in themselves and you know so therefore how do how do people admit to themselves and maybe to others that they've got a problem here i don't know whether perhaps andrew whether you want to start on this one and other people come in it's it's tremendously difficult i mean i remember someone working in uh alcohol services in my local area saying that it it'd be easier to get planning permission for a pub than it would for an alcohol treatment center and that that's all really highlights the the the sort of twisted logic of our society sometimes and that we're generally quite jocular i i think the the british in particular are quite fond of joking about alcohol in a way that perhaps other nations don't um and but then when alcohol becomes a problem we're not too sure what to do with it we think it's all a bit embarrassing and you might want to perhaps get that person out the way somewhere or or somehow minimize the the problem that they're causing to themselves and others and i think it does uh make it very difficult and i always say whenever i'm um visiting uh people in recovery in in in normal times i try i normally spend one morning a week with with people in in recovery from alcohol and i always say to them look people people probably look down on you because you're a bunch of drinkers and drug users and things but you're the people who actually stopped to think about what you were doing you're the people who put your hand up and said oh do you know what i think my life is on the skids and i'm gonna do something about it whereas the general society outside that probably thinks it's doing very nicely uh has has not had that difficult moment um and i always say to them i think you've been very brave you know the thing you've done i don't know whether i could do it so it is definitely it is a difficult thing to do to to admit a problem i think that that that statement sorry can i just commit into what andrew was saying there i think it also comes back to the you know what we were talking about at the beginning in terms of the stereotype of who is a problem drinker you know because i mean i've worked over the years in you know with psychological interventions with people who drink and it's so interesting the barriers that we the psychological defense barriers that we put up in terms of what is a problem drinking you say how do you you know admit to yourself or admit to others but it's always the other person not us you know so for example i drink expensive bottles of wine i may drink three of them a night but i can't possibly have a drink problem or be dependent or an alcoholic expensive bottle justify those things you know it's a because it's so i think because it's so embedded in our culture i remember many years ago i think it was in the 1990s the royal college of psychiatrists um referred to alcohol as our favorite drug and it sort of stands doesn't it i mean it's a very simple definition but i think it it stands and it is very much about you know we bat it out to the other other people have problems with alcohol not not us and that's a big barrier to getting help i think and just briefly picking up on the stigma point that andrew raised it's almost as if within british society there's more of a stigma attached to not being a drinker than there is to being a drinker that you know if you're somebody who wants to stop drinking or wants to start drinking non-alcoholic versions of drink that there's almost a a reluctance to admit this even to your own peer group because of the stigma attached with not being a drinker so stigma almost and peer pressure can affect you either way in that situation both in terms of starting but also in terms of stopping yeah okay yeah yeah i would say i'm sorry to we may come on to this in a bit but i would say certainly in terms of alcohol related brain damage you're really talking about stigma times too there in that um you you've got a condition that people might regard as as being self-inflicted someone's brought this on themselves by not desisting with their drinking even though as ramens just said they they may well have gone well beyond the point where they were capable of stopping um and then uh the consequences of this uh damage to the brain is that their behavior then becomes tremendously um inappropriate unpredictable objectionable rude unexpectedly sexual all the sort of things that would really make them quite difficult to deal with um and i think it's one of the reasons that people working on this condition get so passionate about it because the the the client group for one of a better word the patient is is often so excluded and and so uh as regarded as being such low status by society um but as as i'm sure will come on to the condition is eminently treatable and people can recover themselves and and all that strange and objectionable behavior is is not really themselves at all it's it's the condition at work yeah i mean i think obviously you you sort of said that about it is something where it is possible to intervene and to change and and that's i'm just thinking you know maybe if we can move on to to think about how how you would treat people with arbd once people have got to that stage of being able to recognize this this issue which they have for themselves how would you get then go about sort of treating um perhaps i could start with raman yes i think the tree before we go down to the treatment i think one of the key things for me as a clinician is recognition of the condition and the various sort of forms it comes in you see so once we are able to understand that you know when you're going to see a person with alcohol problems number one we need to keep in mind that okay a person with alcohol may have alcohol liver disease but equally as a consequence may have an encephalopathy secondary to that or a direct alcohol related brain complication as well with its different sort of facets once we recognize that i think it is then starts becoming important to have a treatment that covers the multiple dimensions because you know with arbd we're not just talking abstinence that is the key absolute key because once you remove the offending agent you're getting in the right direction but then they have so many other nutritional problems you know physical comorbidities mental health problems specifically stress anxiety you know other depressive disorders and a lot so it is not just one in my view the treatment has to take into account a comprehensive assessment plan and work with them not short-term but as a multi-disciplinary approach for a long period of time there then the legal dimensions start coming up as well in terms of you know people with cognitive problems uh uh as i'm speaking actually i'm thinking of a patient that i'm dealing with currently in the clinic where they are cognitively impaired and we are struggling to actually on the cusp of whether we say this person has the capacity to make decisions for detox or not and if we say they don't have the capacity then it opens up a big armory of other machinery the legislation and the care packages and also i think there's no one single answer to the treatment it is complex as the condition itself yeah so it's complex and it has to be over a long period of time um and you're saying obviously putting in lots of different elements so anything you wanted to add to that julia yeah i mean i think the thing that we need to remember about um albd in contrast to the conditions that it mimics which are the dementias is that if you can assist someone to maintain abstinence from alcohol and as ramen says take a good diet um which might need supplementation with this particular vitamin called thymine if you can do that then up to 75 of them show some degree of improvement the remaining 25 percent won't deteriorate so it's not like you know alzheimer's um that okay we can give drugs to kind of slow it down but it's going to deteriorate anyway if you can help people to save alcohol 25 stay as they are the remaining 75 i can't add up will show some degree of improvement some of which 25 will get a good almost near normal degree of improvement so it's something worth doing about doing something about and you you get quite frustrated because you think if i was standing here with a tablet telling you i could improve 75 of alzheimer's cases people would bite my hands off for it all i'm saying is we need to help people get um the alcohol safely removed from their body which very often means a medically managed detox in a unit that understands cognitive impairment which is often an issue you need to support them to stay off the alcohol now in standard terms that's counseling relapse prevention relax prevention medication but you've got to adapt your counseling to somebody that's got cognitive impairment you can't deliver counselling as usual it's got to be adapted they say support them to get proper calories in the right way with a lot of healthy stuff particularly their vitamins rebuild their emotional lives because they've often because of stigma but they're bridges with their families no family support no friends support you need to rebuild all of that treat any mental health problems they've got because loads of them have got anxiety depression other mental health problems and and sometimes and rahman said you know mentioned with with the patient he's dealing with and i've got a number of patients that don't have capacity to decide hey whether they drink or be where they live and we have to have a range of supportive accommodation of various different times right from nursing homes down to you know care packages in their own home that will help to support them to stay off now what's really really interesting with with a lot of these patients is that because as raman said that stop but at the front of your brain that as isn't working properly anymore it means they re they drink in response to triggers so if they're in an environment that triggers that this is where i have a drink they're gonna drink very often when they're in a different environment they're not pushing for alcohol they're not saying i want to get out and get a drink they often settle very easily and that is a really simple way of saving someone's brain and saving someone's life yet we don't do it so often yeah and i think for you know it sounds like it's a really important message there in terms of you know what you were saying about the the 25 percent 70 percent you know there is you can do even if it's about stabilizing um people and preventing deterioration but also for that 75 you know you're looking at improvement you know and i think that's you know perhaps a key message that everybody you know needs to be aware of i'm just thinking andrew you were saying that you spend quite a lot of time you know with people in recovery and whether there's anything you would want to add here um i think julie julie makes a very sound point there about thiamin vitamin b1 which is um something that might be familiar to viewers of the the old hospital drama er where it was always described as a banana bag because this stuff is yellow and and quite malodorous as well but i know julia and others have said to me over the years that um when you're when you're suffering with a rbd you really you really can't get too much vitamin b into you and it's one of the things that that helps rebuild the brain i mean the other thing i would certainly make the case for is is some kind of occupational therapy i mean julia's hinted there about the living environment but one of uh one of the arbd stories i always remember is the one that oliver sacks used to tell um in in the 1970s which is showing my age a little bit but um he used to talk about the man they called jimmy the lost mariner who was an american sailor who who had a rbd and he said that jimmy recovered uh many of his functions when undertaking two activities which were attending to the garden and attending mass and jimmy was a roman catholic obviously so these were those would be different for different people but these were purposeful activities that meant a lot to him that that he was able to to undertake and and uh dr sac said that jimmy was quite lucid when he was doing these things and i think we we need to look as well as the the medical and the pharmacological side we need to look at those aspects of someone's humanity and their personality that that they can recover be it gardening or mass or bowling or or whatever it might be so perhaps not taking a strengths-based approach where you're looking at areas of their lives which are good and you can build upon that's that's very good way of putting it i've not thought of it like that but yes that's certainly what it is yes yes and i think in you know i'm just complimenting what you think andrew that you know christopher reeve the old actor who got the spinal column sort of uh gone and then had paralysis he was one of the in my view the pioneers who changed the way uh doctors or the medical profession thinks about neuronal plasticity because with the recurrent uh stimulation and activities he was almost able to rebuild the connections from the brain to the spinal cord to be able to do that which takes us to the point of you know the brain's plasticity to adapt and improve so if we are looking at the nutrition we are looking at inside of things if we make them that remits of nero rehab where you are purposefully making activities designed to tailor to that individual's needs then the brain has a chance to improve and recover yeah so i mean it sounds from everything that ever well everybody's been saying that you know it is important there are things which we can do it's important that we we look at these both in terms of recognizing and actually intervening and ongoing support now that probably requires quite a coordinated effort to get that to happen so i'm just wondering what advice all of you would give to policymakers and politicians about what needs to happen in terms of maybe managing responding to arbd and i'll probably ask everybody on this one i think so if i start with gareth just you know what what would be your start to pretend on what we need to be saying to policymakers and politicians well there needs to be an awareness of it to begin with to raise awareness of of arbd and then that needs to feed into joined up thinking so there needs to be um clear ideas of how interventions should be should be offered and what what the pathways for those those interventions should be so that that would be my start for 10. okay what about yourself julia what would be your message to politicians i mean i think that the really important point that gareth made is it it's a pathway you're not gonna set up a duty little service with one doctor two nurses and a support worker and it's gonna deal with everything from arbd i mean i i run um an arbd clinic and i get asked to do things all the time that that is not my specialism but it's attached to a rbd um and i have nobody else to call on so it's a pathway it's a multidisciplinary pathway it has to work properly one of the difficulties we have is when um policymakers and and you understand why this is the case because they are keepers of the public poos at the end of the day but they want to know the size of the problem and as gals already mentioned we don't know and this i think to my mind has been one of the biggest blocks that we had to getting anything policy wise now what may help us is that the joint departments of health and public health are currently um putting together a set of national guidelines for the management of alcohol misuse um across the uk we've had guidelines for the treatment of drug misuse for for a number of years everybody calls them the orange guidelines but we're going to get some for alcohol and within that there is a section on arbd now i i'm honored to be cheering the group that's writing that bit but that that section is saying exactly theirs and we've got the absolute guru of arbd professor kenneth wilson as part of that group so you know if ken says it's it's law because he is god um and and this whole bit about it's a comprehensive package of care will be stressed massively in that section and and so it's you can't as um old age psychiatry memory services say it's not our bag yeah it's part of your bag you can't as a care home for young brain-injured adults say it's not our bag yes it is it's part of your bag and ot's and physios and psychologists and psychiat everybody so that there has to be an acknowledgement that you're not going to make little services they're going to trot off and sort it all out for you okay so it's it's about having that focus but also the links and the coordination and uh sort of network there but what about you what would be your thoughts about what politicians policymakers need to take on board well absolutely what they've both just said um definitely um i think um the you know just i suppose repeating in some ways but one of the the issues around um thinking is is clearly it's a bit of one of these catch-22 sort of um situations really in that there is a lack of awareness you know there's a lack of understanding in terms of prevalence and you know sure you know one of the first things commissioners want to know is well how big is the problem before they start um throwing in many at things but also there just seem to be so many points potentially of contact for um patients potential patients service users and or their families friends people who care about them at different points across the sort of you know the broad spectrum of services and um um different settings so having some sort of way of identifying you know for the people who are the first points of contact if you like so you know so what we're one of the things we're thinking we're trying to do at the moment we've got a bit of research ongoing around sort of developing some sort of brief screening assessment that's not i mean it's a complex very complex area but in terms of just giving sorts of frontline you know care workers key workers you know whatever just a light bulb moment if you like that this person in front of me obviously needs specialist assessment at least to see if they need help and are on the spectrum of of conditions and i think if we can get policy makers to sort of understand a bit about the sort of resources in terms of you know awareness training at that very broad base level often with lots of complex conditions we need the people at the people at the very base of that in terms of who people come into contact with first and i think that's an area that um policymakers should be you know public health should be thinking about as well you know it's important that everybody knows about this okay so it's about raising awareness not just as much generally but also specifically within those individuals whether they're health social care professionals who might have that contact who might be able to ask the questions and start things happening yeah it's almost like a sort of again you know back to some sort of traffic light thing but just if people can flag up because of the potential for recovery and helping people you know i mean obviously it's important to intervene as early as possible in any condition but when it's something that has the potential you know before people tip into that 25 where they're just not going to get any worse and even that is better than just leaving them to actually you know end up dying of this then i think it's absolutely crucial and um you know the awareness needs to extend to policymakers and you know people in that position as well doesn't it because obviously they can't be experts on everything but you know so it's like just to get that message across i think okay robert is there anything you would want to add to to messages to to politicians and policy makers i think uh i i want to just re-emphasize what you all have already said the having a central database is very very crucial and how we develop that would have to be from the various you know coding systems that are used and you know people coming in for alcohol problems need to stop we need to start looking at how do we code them is it from the a e is it from the gastroclinics as it from the trauma centers now i started doing a little bit of digging about uh this because of my interest in traumatic you know the brain injuries now there is a huge match national database for trauma and orthopedics right across the uk not just whales where all head injuries or brain injuries are recorded as such an interesting discussion i had with one of the ortho pods was what happens to those people who've had those brain injuries because of whatever causes i think number one causes is road traffic accidents and alcohol uh well they are treated but then they are off in the community where are they who sees them what is the psychiatric burden of all of those people we don't have that so i think a triangulation of all of that data from various sources is very very important to build that is that we need specialist arbd services and we can't just uh you know borrow from tom and give to peter to you know run uh you know some of these services and the additional thing is regarding training and i think bev has already put that across the training needs to happen for right across the patch and one of two big challenges that i come across in this part of uh this work is people tend to be afraid of doing a proper cognitive assessment uh they rely heavily on just screening tools which may or may not give us much detail so we do need to train people up to doing good comprehensive you know cognitive assessments and some sense of basic neurosciences neuro radiology so you know trainees colleagues are gradually gravitating and asking me to interpret their brain scans for them which unfortunately i've developed that skill over the years so i started doing some talks on basic uh you know neuroradiology but those kind of things would be very helpful for the vast uh you know trainees consultants other colleagues to actually start looking at some of those brains that you're treating your patients so at least you can see that brain and what are you actually looking at and that i find very useful because you can sometimes show the films to the patients and feel that look this is what your brain looks like and if you know if we can do something it makes change and that is sometimes a light bulb moment for people that okay and then some positive behavioral change begins to happen okay so training is really important and making sure that the right people get the right training um to be able to take this forward so finally i'm just andrew is there anything you would add to i i don't think i got a great view to add there i think because as uh as julie said the message to people in the caring professions and and to commissioners and service planners is that this is your bag um it might not look like it and it might not be a very appealing bag sometimes but it certainly is yours okay so i think we're probably coming towards the end of the discussion now and i think it's it's been really interesting for me coming to this probably from outside of the area i suppose there's a few key messages that have come through you know it's i think that the one that you've just made there andrew about it everyone's back i think is is an important one for us to remember i think the bit about the potential for recovery the fact that you know either people could we can either stabilize or we can recover but for that to happen there's got to be this awareness i suppose a number of different levels an individual level a service and professional level at a policy level and also at the societal level because i think a number of you commented upon societal influences here um and the fact that there needs to be if you want good coordination yes we need specialist services but that's that's part of the jigsaw it needs to coordinate with other areas so i'm just you know i say we're coming towards the end i just wanted to give everybody just a you know two minutes if there's anything which you haven't had the chance to to sort of um sort of raise um i'll start with with um julio is there anything that you would want to add to the discussion before we end i would just say anybody that's listening think about how much you drink think about how much you got upset with lockdown that you couldn't go to the pub think about what it would be like to go two weeks without drinking whether that would annoy you um it does is good just have a little reflection now and then about our favorite drug thanks i would very much um echo what julius just said there and um you know i mean we're all very good at kidding ourselves but you know on this one don't kid yourself you know you we know that you know gps if you if you the gp asks you how much you drink we know that they double whatever you said you know it's a standard thing but you don't don't do that to yourself because you know you're only fooling yourself and just be honest because 35 units a week is not actually that much to a lot of people yeah andrew something you would want to add um i mean julia makes a very good point about lockdown i i think uh a lot of the problems may have shifted from the pub to the home which is uh always interesting in that you you've lost that sort of natural break that the the barman might provide or the the landlord might provide and uh it'll it'll be interesting to see after this um it'd be interesting to see what our drinking habits look like say in a year's time and whether some of that heavy home drinking is continued or whether whether it was just a blip you know roman something you would want to to add i think i'd just like to add as julia had earlier mentioned that think about alcohol but also not just think about alcohol in your liver but start thinking about alcohol and your brain okay garrus uh well i think i'd like to big up wales as my my my final comment um you know this this has been identified as an issue in wales and we we've got research going on we've we've got you know excellent clinicians we've we've got terrific policy advisors don't want to embarrass anybody who's on this particular particular call um and you know we're in the position to be able to respond to this as a public health issue so you know when policymakers uh sit up and and listen we're in the position to do something about it and be leading the way on it okay well thank you everybody for a really interesting and informative discussion i think you've clearly shown why raising awareness around arbd is important um you know and i hope that everybody listening in takes away the key messages that you've so clearly put across so thank you everyone thank you you

Channel: University of South Wales

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Keywords: University of South Wales, University, USW, Uni South Wales

Id: 44b6c4EH5m8

Length: 44min 56sec (2696 seconds)

Published: Mon Nov 16 2020