Wednesday, 24 July 2013

Alcohol, young women and breast cancer

I'm a firm believer that if you want to get messages across to young people they must be credible and resonate with them in some way. If you start talking about risks that aren't important to them at their time of life, it's unlikely that they will take notice of them. What is the point of talking about drink driving with 15 year olds? They've got a while to go until they're driving themselves and realistically, as much as many of them can't wait to get behind the wheel of a car, trying to give them messages about driving safely is just not going to work until they are just about to drive or have just started driving.

As much as I think it is important to talk about the impact of alcohol on the brain and the liver to young people - you really have to pick the right time. Too early, and honestly, most of them couldn't care less. Potential liver damage is frightening (and very real, particularly for young women) but it's an alien concept for many and certainly isn't a message that is likely to be heeded by teens totally embedded in the party culture - it's just not going to happen to them!

The one thing that does appear to have some traction with young women is the link between alcohol and breast cancer. I'm not sure why it has the impact - could it be that so many young women are actually touched by the disease (i.e., they know someone who has been diagnosed with the condition) or is simply due to the fact that we talk about breast cancer so much and that so many famous women have come forward to talk about their personal experiences? Whatever the reason, this is one alcohol issue that does seem to make young females sit up and take notice.

So what do we know about the link between alcohol and breast cancer? The Cancer Council has a Position Statement on the issue of alcohol and cancer risk that is a great summary of the evidence in the area. One of its key messages is as follows:

"Alcohol use is a cause of cancer. Any level of alcohol consumption increases the risk of devloping an alcohol-related cancer; the level of risk increases in line with the level of consumption."

When it comes to breast cancer in women, according to the Cancer Council, there were 12,170 cases diagnosed in 2005 in Australia. Frighteningly, 2,677 of these were attributable to alcohol use. The actual role alcohol plays in causing breast cancer is not completely clear but it appears it could be due to excessive alcohol use (particularly in the late teens and early 20s) mutating the breast cells (possibly by increasing oestrogen levels) in some way. Then when the woman enters menopause later in life, these mutated cells become cancerous. Most of the evidence in this area focuses on those women who drink to excess, however, more recent research is now suggesting that even light drinking could cause problems. A recent study from the International Agency for Research on Cancer found that there could be as many 5,000 breast cancer deaths a year attributable to just light drinking (up to one drink a day). Based on this evidence an editorial in the medical journal Breast concluded "women who consume alcohol chronically have an increased risk for breast cancer that is dose dependent but without threshold". 'No threshold' means there is apparently no level of alcohol consumption that doesn't raise breast cancer at least a little.

But it is those who have a family history of breast cancer that are most at risk from drinking alcohol. One study suggests that women who are frequent drinkers who have a close relative who had had breast cancer are more than twice as likely to develop the disease themselves than those who do not drink. It is therefore important to get a message to young women to be aware of this risk and drink as responsibly as possible if they have a family history of the disease. It's important not to try to terrify young women in this area but certainly they need to be told about these risk factors so they can make informed decisions.

I had just finished presenting at a Parent Information Evening and three women came up to me and wanted to thank me for the talks I had given to their daughters through the day. One of the women said that she had been trying to communicate with her daughter about alcohol risks but this was the first time that she believed something had got through. Two of the women were wearing headscarves and I should have realized at that point what they were referring to but it wasn't until they told me that all three of them were breast cancer survivors that it finally sank in! They all had teenage daughters who were into the party scene and they had tried to tell them that due to their family history they were at greater risk and needed to be more careful with their alcohol intake, but it was to no avail. Their daughters believed that their mothers were trying to control them and it wasn't until an 'outsider' (me) had come to the school and discussed the link between alcohol and breast cancer that they finally realized that the risk was real and that they needed to moderate their drinking because of their family history.

I don't think for one minute that providing this information is going to stop young women drinking (and that's certainly not what I'm going for!) but the evidence is now stronger than ever before that there is a link between alcohol and breast cancer. When you think that almost 3,000 of the breast cancer cases diagnosed in Australia each year are attributable to alcohol use, if we can prevent even one woman from going through this experience by reducing the amount she drinks in her late teens and 20s simply by providing some simple information on the risks it certainly is worth the effort!

Saturday, 20 July 2013

Alcohol and vomiting

Most people have vomited at least once in their lives. In fact, many people have a great vomit story – particularly relating to their alcohol consumption! Though unpleasant, vomiting can be the body's way of protecting itself, trying to get rid of harmful toxins. Alcohol is certainly a powerful toxin ...

For many young people vomiting is the most likely reported negative outcome that they experience when they drink alcohol. In the 2011 ASSAD survey more than one in five (21.6%)12-15 year old male current drinkers (those who drank in the previous week) and well over a quarter of females (28.5%) of the same age reported vomiting after drinking in the past 12 months. Not surprisingly, far more 16-17 year olds were likely to report the practice, with 45.7% of male current drinkers of that age and 45.8% of females vomiting after drinking alcohol.

What continues to concern me in the school context is how few young people I meet who have any idea how to look after a vomiting friend. Even more worrying is the growing number who believe that vomiting is just a part of the 'drinking process' and that it is just a bit of fun and nothing can go wrong. One of the first deaths I was ever involved with was almost 20 years ago involving a vomiting young man.

A 16 year old had been having a big party night. It was a friend's birthday and a large number of teens were partying at the birthday boy's home. The parents had not supplied alcohol but partygoers were able to bring their own and there were a number of teens who were getting pretty intoxicated. The young man started to feel unwell and told a couple of his mates that he was going to the toilet to throw up. No-one thought anything of it and he wandered to the bathroom. When he didn't return a couple of guys decided to go and check on him. Unfortunately the bathroom door was locked when they got there and when they knocked their was no answer, although they could hear what they thought sounded like a gurgling sound. Eventually they became extremely concerned and broke the door down. The young man was curled over the toilet - he had passed out while throwing up and had choked on his own vomit.

Since that time I have been involved with a number of alcohol-related deaths due to vomiting. It is not a 'bit of fun' and it certainly isn't harmless. No-one should ever be left alone when being sick and every young person should be provided some basic information on how to look after someone when they are vomiting. What constantly amazes me is how many parents think it is perfectly okay to send their teenager off to a party on a Saturday night yet not provide them with any skills on how to look after themselves or their friends. When you look at the figures above - almost half of all 16-17 year old current drinkers had vomited at some time after drinking - how in heaven do they know what to do when that happens?

So what causes someone to be sick on this most popular drug?

Most alcohol is metabolized by the liver, where an enzyme called alcohol dehydrogenase, or ADH, breaks down ethanol into acetaldehyde, which in turn is broken down by another enzyme into acetate, which is excreted. The intermediate product, acetaldehyde, is a toxic chemical that can make a person feel sick. Although under normal circumstances acetaldehyde is broken down quite rapidly, intense feelings of nausea and illness will result if it is accumulated in the body.

Alcohol is removed from the body very slowly, at a rate of about one standard drink per hour, so if you drink too quickly the toxins build up in the body and your body needs to expel them. That’s where vomiting comes in – your body doesn’t want the toxins anymore and as a result the stomach’s contents are expelled!

Apart from choking on their own vomit, there are other ways that deaths can occur when someone is sick after drinking. Dehydration and salt imbalances are the biggest concerns in most vomiting episodes. Signs of dehydration are increased thirst, infrequent urination or dark yellow urine, dry mouth, eyes that appear sunken, crying without tears, and skin that has lost its normal elasticity.

Of course we can't call an ambulance to look after every vomiting drunk teen, but having other drunk adolescents looking after someone in this condition is not a good idea. Calling a responsible sober adult to assist is most probably the best thing to do in most cases, but how do you know if a person is just drunk or actually suffering from something much more serious - like alcohol poisoning? It’s difficult, but a basic rule of thumb is that if you see any one of the following, you should seek medical help immediately – this is not something you can deal with alone:
  • the person is unconscious and can’t be awakened by pinching, prodding or shouting
  • the skin is cold, clammy, pale or bluish or purplish in colour, indicating they are not getting enough oxygen
  • the person is breathing very slowly, if there are more than 10 seconds between breaths – this is an emergency
  • vomiting without waking up
No vomiting should be taken lightly – no person who is vomiting should be left alone – people do die from choking on their own vomit. And it doesn’t take much – it is believed that a person can choke on one tablespoon of vomit which can build up and block the airway!

Saturday, 13 July 2013

Young women, alcohol and sexual assault

In one of my recent blog entries I talked about a conversation that I had had with a group of 15 year old girls who had not reported that two of their friends had been sexually assaulted because they believed "that's just what happens when you drink". When I told them that rape was a crime and that it didn't matter whether you were drunk or not they appeared shocked.

The first time I meet a group of school students and deliver my Year 10 presentation I always raise the issue of sexual assault. It's discussed in the context of 'alcohol makes you vulnerable' - for young women it's sexual assault and for young men, robbery and violence. It is without doubt the most confronting part of the talk and it is not unusual to have a member of the audience (typically a young female) have to leave the session as they become more and more distressed with some of the stories I tell. In most cases this is due to the fact that they either know someone that has experienced what I am talking about or they have found themselves in such a situation at some time or another.

I watch the audience carefully and try to spot anyone who may be distressed but not want to identify themselves to the rest of the room. If I do, I make sure that a teacher is told that he or she needs to be followed up. I have to admit sometimes I battle with whether or not putting young people who may have had such experiences into this potentially uncomfortable situation is appropriate but recently I received an email from a young woman that reinforced that the message I deliver is a positive one.

I have edited the message down and removed any identifying information but have not altered anything else ...

"I just wanted to thank you for your talk that you did for us ... I want to tell you what happened to me, I hadn't told anyone and I had tried to forget it myself until that story you told us about the 14 year old girl who got drunk and couldn't remember anything brought back memories that I had never dealt or come to terms with. I hated your talk at the time because it was bringing back so many painful things but now i'm starting to deal with them which i had never done. 

When I was 14 i started drinking and getting drunk .. I don't remember most of the night, I had probably 12 standard drinks. I just remember trying to walk somewhere and not knowing where I was, being pushed around and to the ground and trying to push him off me. I can't remember anything else until the next morning when I woke up in a tent at a friends house, not the one I was originally staying at, with bruises and scratches. one of the guys that I was friends with who was staying there said he had found me at 4 in the morning a few blocks away stumbling around, he said he had to carry me because i couldn't support myself. People at the place where I got drunk said I left at around 12, so no one knows where I was for 4 hours. In a sad way i feel fortunate that I can't remember it. I never told anyone and I hadn't thought about it in a long time until you told us that story that was similar to mine. I've now told my sister the whole story and i'm starting to see someone to help me deal with that and some other things I haven't dealt with. 

So I just wanted to say thank you, because I wouldn't have told anyone this if it hadn't have been for your talk ... If my friends had known more about how to look after someone as drunk as I was and not let me out of their sight (although its pretty obvious, they just didn't think about it) what happened to me probably wouldn't have. Your talk was one of the most beneficial things that has happened to me in a long time so thanks."

I believe that the rate of alcohol-related sexual assaults amongst school-based young women is almost reaching epidemic proportions and no-one is talking about it. Unfortunately, girls are not coming forward to report the crime because they either believe it 'just comes with the territory' (i.e., it's just part of the alcohol experience') or due to the associated shame and stigma (e.g., once I was told by a 15 year old girl that she 'deserved' it because she had got drunk).

But as with the whole 'drink spiking' debate, why should the onus just be on women taking responsibility for this crime - how about the young men who are actually committing these unlawful acts? Unfortunately young men's attitudes towards alcohol are a reflection of what we see in the general community and even though they truly care about themselves and their friends, when alcohol is added to the equation, their value system can change and their attitudes, particularly towards young women that like to drink, can be frightening.

One of my greatest concerns is how a 15 year old drunk young man perceives a young drunk girl. She is now no longer seen as the same as your sister, your best friend or someone else you may care about – she is now seen as a 'slut' or a 'bitch' and becomes fair game. In fact, there is a growing perception by some young men and boys that the very reason she chose to get drunk is to have sex – with absolutely anyone!

When I tell a group of young men that it is a crime to have sex with a drunk girl because she cannot consent, that even if she says 'yes' at the time she could wake up the next morning and change her mind, the first response is always the same – "if I wake up after having sex and she is ugly can I change my mind? Am I able to say I was sexually assaulted?" There is no consideration given to the drunk girl that has been sexually assaulted – she doesn't seem to matter. I find this deeply disturbing.

In my Year 10 presentation that I discussed above the response around the sexual assault issue from both young men and women is phenomenal. In fact, I would have to say that boys respond even more strongly than girls, often outraged that someone would even consider sexually assaulting an innocent girl, but I do have to choose my stories carefully – if the female went out and made a 'mistake' and drank too much (i.e., it was out of character) that is okay, however, if she was a party girl and this was just a normal night that went wrong, well that's her own fault!

How do we change these attitudes? How do we encourage young women who have been sexually assaulted to step forward and report these crimes? And perhaps, most importantly, how do we get young men to improve the way they regard young women, all young women, whether they have been drinking or not? As already said, adolescents' attitudes towards alcohol are a reflection of what we see in the wider community and what they see is not good ...

We need to keep talking about alcohol-related sexual assault, whenever possible, across the whole community, making sure that everyone understands that it is a crime, just because she is drunk doesn't make it okay. These crimes need to be reported and it must be made clear that just because a young woman gets drunk (or even simply drinks alcohol) it does not mean that she is providing an open invitation to absolutely anyone for sex!

Thursday, 11 July 2013

Teenage parties and business opportunities: Promoters, photos and privacy

One of the consequnces of parents increasingly being unwilling to put on teenage parties due to the fear that they will get out of control is that when a 'gap' is created in the market there is always someone willing to fill it and try to make a quick buck out of it. Unfortunately, often those people are fairly unscrupulous and some of the activities that we are seeing are worrying to say the least.

Across the country law enforement are most concerned about party promoters who organise events targeting adolescents and then market  these via social media. There have been a number of these large scale parties or 'gatherings' that have ended up getting seriously out of control with hundreds of teens of all ages turning up, often resulting in some fairly serious anti-social behaviour by some of the partygoers leading to major problems for nearby residents and police. In response, the Queensland Government recently announced that they are considering new legislation in an attempt to control these type of events, enabling them to prosecute the promoters who are willing to take money from young people but not assume any responsibility if anything goes wrong!

In Adelaide over the past couple of years there have been a number of young people who have built businesses targeting post-formal parties for Year 12 students. These enterprising young people find a venue, hire djs, organise transport and then create and send out letters to students from a range of schools inviting them to what appears to be a completely legal 'after formal' event. The letter usually contains some mention of an alcohol limit for each young person attending (usually a four can limit) and discusses a fee that those wishing to attend must pay prior to the event. Here are some excerpts from one of those letters that did the rounds last year:

"There is a fifty five dollar entry fee for the event: this money will go towards the hire of the venue, marquee, dance-floor, toilets, stage, audio visual equipment, security and catering ... If money is not received by ..., spots will not be allocated to those guests who have not paid."

"It is of great importance that parents understand that there will be alcohol at the event. Alcohol will not be supplied, but each guest is permitted to bring a maximum of four drinks per person. Drinks must be brought in CANS only - bottles will be confiscated. This will occur under the supervision of the organising parents and security ... Whilst it is not illegal for persons under the age of eighteen to consume alcohol on private property, it is important that all parents are made aware that alcohol will be available and may be consumed ...."

The letter is five pages long and contains a great deal of information and it really does seem like the organiser is a professional who has been doing this for years. It also appears as though this is a school-sanctioned event with the name of the school being mentioned a number of times. This certainly wasn't a school event, however, and it appears that the organiser was in fact a young man who had only just recently finished Year 12 himself! It was also a completely illegal event. When we checked with SA police and showed them the letter they made it clear that there was no way the event could take place without a liquor license - because of the all inclusive fee the organiser would need a license, even if he was not supplying the alcohol himself. The police would have shut the event down if it had actually started and it is highly likely that the young man would walk away with a healthy profit, not making any mention of refunds in the letter.

But I was recently contacted by a parent who was worried about another type of business connected with teenage parties - a company that offered a photography service linked to Facebook for those holding such events. Her daughters were both invited to a party on a Friday night (both did not attend) but after the event had taken place her eldest child showed her some photos on FB of the 'gathering'. There were a range of concerns that the mother expressed in the email including the fact that there were children from Year 8 up to Year 12 (from several different schools) present and it was clear from the photos that there was alcohol being served, but her main worry were that these photos were posted on a public Facebook page (I won't name the company for a range of reasons) and were available for the world to see .. Here is some information that could be found on the company's FB page:

"Here at (name of company), we know that the holidays are a time for relaxation. And for most of you, 'relaxation' means partying. As such, to celebrate the much anticipated term break, (name of company) is offering a very special school holiday offer. If you're a high school student hosting a party between the 6th and the 21st of July, you can get a photography package valued at $150 for only $20. That includes: 1 full night's photography; every picture individually edited to perfection; and 1 complete Facebook album on the (name of company) page - immortalising your party."

It needs to be made clear that the majority of parties on the FB page look as though they are 'over 18 events', however, the statement above is clearly targeting high school students, the majority of whom would be underage. Worryingly, the page also contains the following caveat:
 
"*(Name of company) is not responsible for the content captured at any events. This includes, but is not limited to: nudity, drugs, alcohol and anti-social behavior."

They do state that if anyone has a problem with any photos that all it takes to have them removed is to "message the page and photos will be taken down", but you have to wonder how long it would take for someone to find out that there was an image that was problematic. The caveat is a huge worry - basically they're saying that if someone is upset by an image, they are accepting no responsibility!

The mother who contacted me had found out from a young man who had attended the party how the photos were taken. Apparently the photographer was 'young' himself and partygoers had to go up to him to 'ask' to be photographed. She questioned whether the few boys she had noticed passed out in the background in a couple of the photos had actually been able to give their permission. She was also worried that teens who were at the party were tagging themselves and commenting on the photos so that the photos were appearing on a growing number of young people's 'walls'.

Young people need to attend teenage parties - that's where they learn to socialise. Increasingly, however, we are seeing younger and younger people being encouraged by these type of businesses to take part in what are essentially adult activities. This photography company is a classic example of this - the FB page is full of photos of adult events, yet it also actively targets underage people and then puts images of the two side by side.

Realistically it all comes down to good parenting - if your teen wants to attend a gathering on the weekend, it is vital that you find as much as you can about the event. That includes who is holding it, how it will be run and who is attending ... unfortunately for some parents it seems as if that is just too difficult!

Saturday, 6 July 2013

Does ecstasy really contain crushed-up glass?

I received a couple of emails from readers of my latest blog entry that dealt with the issue of possible 'adulterants' in LSD asking the question "what do manufacturers of illicit drugs actually put into their product and how harmful could these be?"

Many people, including many drug users themselves, believe that illegal drugs can often be 'cut' with a variety of different dangerous substances. These can range from products found in the laundry cupboard, such as washing-up powder and bleach, through to rat poison, kitty litter and crushed-up glass. There is also the belief that sometimes, other more dangerous illicit drugs are added, either to add to the effect or to get the unsuspecting user 'hooked' on the other substance. This is particularly true when it comes to ecstasy, with many users believing that some pills contain heroin (often referred to as 'smacky E's'). Cannabis users will often talk of hearing that the plant is 'laced' with other substances (in recent years I have been asked by young people, users and workers alike whether there is evidence to suggest that cannabis is sprayed with heroin, amphetamine and even ketamine!).

In actual fact, there is little evidence to support either of these beliefs. Before we look into the facts behind these myths, it is important to examine why these beliefs may exist in the first place.

Firstly, due to the information that we often provide to the community about illegal drugs in regards to the way they are made, it is commonly believed that little care is taken during the manufacturing process. We tell young people that drugs such as speed and ecstasy are manufactured in 'backyard laboratories' and, as a result, that any products could be used in the mix. Secondly, we constantly reinforce the fact that people involved in the manufacture and supply of drugs are believed to be capable of just about anything and so it seems reasonable to believe that they would do incredibly irresponsible things like this.

In reality, this is not always the case and to be quite truthful, if manufacturers did start to include things like rat poison in their mix, we would very quickly see the results and they would start to lose business! Although the labs used to make illicit drugs are not the same quality as those used by pharmaceutical companies, it is highly unlikely that the chemists have boxes of rat poison hanging around that could accidentally fall into the mix. Without a doubt, organized crime is unscrupulous when it comes to increasing profits and they're not really going to care about the misery that their products could inflict on the users. However, one thing everyone needs to remember is that the manufacturers and dealers want return business. If they were making and selling products that contained some of the things that are often discussed, their business would dry up fairly quickly.

Drugs that are seized by police are routinely tested both here and internationally. There is a great deal of forensic evidence available and many of the substances often discussed have never been found. Drugs definitely have things added to them to improve profit margins, but usually these products are fairly benign and may include paracetamol, caffeine, glucose, lactose and other sugars. Bicarbonate of soda and Epsom salts are also sometimes found. Of course, if you're talking about pills and tablets, a variety of starch and gums are also used to bind the drug together.

Unfortunately sometimes urban myths like this are picked up by people who should know better and results in media reports and a wider belief that there is some basis in fact behind it.

Many years ago a story ran in many newspapers across the country about ecstasy being tested and crushed-up glass being found as a result. The story originated from a politician who had issued a press release warning about the possible dangers. As you can imagine this received huge attention and I was asked to make comment on what I thought about this discovery. I was quite surprised by the story and before I was willing to make a comment to the media I contacted the politician's media officer. When I spoke to him I asked him where the information had come from as I was very surprised that I had not heard of such results before. There was a lot of mumbling and fumbling on the other side of the phone and after a while he said he would have to get back to me with his source.

Finally I got a phone call from a very junior member of staff who told me that the information from the press release had originated from a well-known south-east Asian newspaper. Someone had read an article whilst on holiday that discussed crushed-up glass being found in ecstasy pills and had brought it back to Australia. There had been no effort made to verify if there was any truth to the story, they just put the information into the press release and the rest is history. When I made a follow-up phone call to express my concern about the story an hour or two later I was told by a more senior staff member that the phone call I had received never happened! They knew nothing about a "south-east Asian newspaper story" ...  

To this day I still get questions about glass being found in ecstasy. The myth has been around for years and there is no evidence to support it. The story even attempts to explain why glass would be used, i.e., to make tiny cuts in the stomach to enable the ecstasy to enter the bloodstream faster, enabling the user to experience the effect of the drug in less time. Really!!! Also, it is also important to remember what 'crushed-up glass' actually is - that's right, it's sand! After discussions with others in the field, including some toxicologists, there is the belief that this is where this myth may have originated - testing was conducted at one time or another and sand was found in a batch of pills. When the results were written up and issued to the public, to make it more sensational - 'sand' was changed to 'crushed-up glass' ... I don't think we'll ever know if this is truly where this myth came from but I think it's a pretty good guess!

Is it any wonder that young people do not heed the warnings we give them about illicit drugs when even our government issues press releases based on media reports and no available evidence? You keep crying 'wolf' and sadly, when there is an important message to get out there (e.g., there appears to be a highly risky product currently being sold as LSD in this country) , there is no way in the world young people are going to believe a word we say!

When it comes to lacing drugs with other illicit substances in an attempt to entice young na├»ve users to start using them, it is important to consider one important thing – the cost. Drugs are expensive and it just doesn't make any economical sense for drug manufacturers or suppliers to add other costly substances to their products, in the hope that the unsuspecting user may get hooked onto it at some stage in the future.

It’s also important to remember that once again, drugs are routinely tested and if some of these substances had been discovered we would know about it fairly fast.

My greatest concern about this myth is that it diverts attention from the very real issue that the drug the user intended to buy may itself be dangerous. One of my pet hates is when you hear the police talking about a 'bad batch' of drugs currently available on the streets. The problem with this is that it implies that there are 'good batches' available. Talking about adulterants, whether they be legally available products or illegal substances, reinforces the myth amongst drug users that the only real harm associated with their dug of choice relates to issues of purity. All drugs are risky and although the harms are different for different drugs, for different people, they are real and our young people need to be aware of them.

It is important to let young people know that there is no way of being certain what is in any illicit substance – no matter what anyone says. Stories about drugs containing all types of weird and wonderful things such as rat poison and kitty litter are just that – stories. We need to make sure that we don't get carried away worrying about potentially dangerous adulterants that could have been added to the mix. When we do that we lose sight of the incredibly important message that what they are intending to buy holds a certain degree of risk itself.