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Saturday, 22 August 2015

Alcohol vapour, 'alcohol-soaked tampons', powdered alcohol, alcohol enemas and plain old drinking games: Why do some people feel the need to get drunk as quickly as possible?

The story that came out of the UK earlier this week about the bar that pumps an alcoholic vapour into the air ("a sweet mist that smells like a delicious gin and tonic") got me thinking about other ways that people have come up with to get drunk and how they are usually designed to ensure that it happens as quickly as possible.  As the article said:

"Inhalation ... is an extremely efficient approach. Compared to swallowing the stuff, which means travelling through the stomach and intestine before entering the bloodstream and hitting the brain, inhaling it is ever so much faster ... It's also dangerous. Breathe in too much too fast and you risk alcohol poisoning."

Coincidentally, I was asked questions about alcohol vapour twice this week by students, both by young men who wanted to know what risks were involved in the practice. When asked where they had heard about this method of intoxication both told me that they had been sent links to YouTube videos via social media. At the same time there have been stories of moves to ensure that powdered alcohol products don't become available in this country, with public health experts concerned about how these could be used by young people in particular (e.g., snorting the powder instead of converting it into a liquid, attempting to speed up intoxication).

Stories of young women messing around with vodka-infused tampons continue to pop up (although as I have written about in a previous blog entry, this is almost certainly an urban myth) and I certainly have met and in fact interviewed young (and not so young) people who have used syringes to ingest alcohol anally (essentially an 'alcohol enema') in an effort to get drunk as quickly as possible. As far as the teenagers who were doing this were concerned, they believed that it was also helpful in avoiding detection (I remember one 15 year-old girl telling me that she and her friends did this so if the police confronted them in a park at night they could breathe on them and tell them that they hadn't been drinking!).

The desire to get intoxicated (on whatever substance) is quite easily explained - as humans we like to 'change where we're at'. Whether it's that cup of coffee in the morning to give you that quick kick to start your day or that glass of wine in the evening to help you relax after the kids have gone to bed, almost all of us have a need to alter our current state. But why is there this apparent need to get intoxicated as quickly as possible, particularly when it is pretty obvious that the faster you get drunk, the greater the risk? Is this a new phenomenon or have we always tried to ensure that we get an effect as fast as we can?

Much has been said about the 'now generation' - our current group of young people who have been brought up in a society based on instant gratification (although Baby Boomers are often referred to as the first 'now generation' - this group of adolescents' grandparents). Today, no-one wants to wait for anything - a new piece of technology comes onto the market, we have to have it now - in fact we'll queue overnight to make sure that we're the first to have it in our hot little hands! It appears to be the same when it comes to intoxication. Those young people who do drink alcohol don't want to have to wait for the effect of the drug, they want to get drunk as quickly as possible, looking for the drink that is most likely to get them there (usually spirits or spirit-based drinks) and, at the same time, look for novel ways of consuming the product to help speed up the process. Drinking games (a very effective way of getting drunk quickly) have been around for a very long time but now there are actual products designed to assist in speedy intoxication (just take a look at some of the 'alcohol shot guns' that are available on the market - Amazon sells a number of them, including a 'Russian Roulette Shots Gun'!). 

What concerns me greatly about this trend is the far greater risks associated with attempting to speed up intoxication. It doesn't matter what route of administration you're using (you could be inhaling a vapour, snorting a powder, inserting it anally or be old-fashioned and just drink the stuff!), the faster that drug reaches your brain, the greater the potential risk. Almost all of the teen deaths that I have been involved with have involved vodka, with most of them being 15 and 16 year-olds who simply ingested too much too fast - they slammed down a whole pile of the product too quickly, able to drink a lot of it before they felt any real effect. When it did hit them, it was simply too much and they overdosed and died from alcohol poisoning ...

We're seeing the same phenomenon with illicit drugs, particularly ecstasy. I had a question from two Year 11 boys this week who wanted to know what they should have done when a friend of theirs had taken 3 ecstasy pills at once ('triple-dropped') and had collapsed and started to fit! These were 16 year-olds! The reason their friend had taken three at once - to maximise and try to speed up the effect ... absolutely frightening!

The reality is that many of these novel methods of ingesting alcohol are never going to become hugely popular - part of the attraction of alcohol for most adult drinkers is the actual act of 'drinking', i.e., holding the glass, appreciating the taste and the socialising that goes with it. 'Drinking to get drunk' is not necessarily a new phenomenon, but this need for instant gratification by our current generation of young people (possibly passed down by their parents and even their grandparents according to some), is particularly worrying. Some of these new ways of ingesting alcohol are highly risky in a number of ways, but we should never forget that simply drinking too much too fast can result in death, particularly as far as adolescents are concerned.

Saturday, 15 August 2015

What does '4 drinks' actually mean as far as a young person is concerned? How much are they actually drinking?

Earlier this week I discussed (again) the bizarre phenomenon of parents hosting post-formal events who include on the invitation that those young people attending are able to bring up to four cans to drink at the event. As I said then ... "Do the parents hosting this event realize how much alcohol that actually is?" Even if each can (or bottle) was the equivalent of one standard drink (which it rarely is), that is still four standard drinks ... The Australian Guidelines to Reduce Health Risks from Drinking recommends that "for healthy men and women, drinking no more than four standard drinks on a single occasion reduces the risk of alcohol-related injury arising from that occasion" - and that's for adults! No number of drinks is recommended for those under 18 years of age, with the guidelines stating that "not drinking alcohol is the safest option."

Once again, I realize that 'not drinking alcohol' is not realistic for many young people, but this idea that four drinks is an appropriate (and safe) number for parents to provide to their teens is frightening.

To find out if this issue spreads further than just post-formal events, during the week I spoke to a number of students from Years 10-12 and asked them some simple questions about the last time they drank alcohol. I wanted to know who provided the alcohol, how much they provided, what type of alcohol was it, and how much they drank (did they drink more than they were given?)? I also asked what context they consumed the alcohol - i.e., at home, parties or gatherings, pre-parties or elsewhere. Now I realize that the results are not scientific and may not be representative (although I'd love to do a real study on this!) but they certainly appear to indicate that amongst the parents of those young people who do drink alcohol, there appears to be a poor understanding of the sheer amount some of them are consuming and the potential harm associated with such behaviour. Also, I was amazed to find out how many of these young people had the alcohol provided to them by their parents.

Although alcohol was usually consumed at parties and gatherings (almost all of the Year 12s reported drinking in this context), the younger the students, the more likely it was to be drunk at pre-parties where there was no adult supervision. Some of the older young men drank beer (usually Year 12s), but the majority of them drank spirits (vodka or bourbon) or spirit-based drinks (UDL bourbon-based drinks being the most popular). Every girl who said they did drink had consumed vodka or vodka-based drinks (Smirnoff Double Blacks being the way most popular). Most of the alcohol consumed by the Year 11s and 12s was supplied by parents, with the rest saying they had bought it themselves because they had part-time jobs. The 10s were very mixed in their response to this question. Some had got it from their older siblings, others from friends or partners (particularly the girls with older boyfriends), while the rest had parents who provided it. Interestingly, of those that were given alcohol by their parents, only about one third of them drank more than they were provided (those that did drink more drank an awful lot more than they were given - some of them double the amount, usually by way of sharing a bottle of spirits with a group of friends!). This may sound like a good argument for parents to actually supply the alcohol, but when you see how much they were actually given, it's not surprising that they didn't drink more! When asked why they only drank what they were given, most of them said that amongst their peer group it just wasn't acceptable to drink other peoples' alcohol - you drank what you brought with you or what you bought and paid for together.

Of those who were given alcohol by their parents, the sheer amount provided by many was staggering and clearly illustrates that some parents simply don't understand how much alcohol is in a can or bottle that they hand over to their child. Some of the responses to the question were as follows:
  • "My Dad gives me a 6-pack of beer to take with me. I've been given that since the end of Year 10. They don't want me to drink spirits like my mates." (Year 12 male)
  • "I have three Smirnoff Double Blacks, sometimes 4 depending on what kind of party it is and whether my parents know the people who are hosting it." (Year 11 female)
  • "Usually 4 bourbon and cola UDLs. My parents have said that if they catch me drinking straight spirits then that'll stop but they've been giving me this much since the end of Year 10." (Year 11 male)
  • "Two Smirnoff Double Blacks. I told my Mum that all my friends drink vodka and that I think that's dangerous and I am able to better control my drinking with these drinks and not get into trouble." (Year 10 female)
  • "Four beers and never anymore. Mum and Dad have said they don't want me to drink spirits and have said that beer is safer. Some weeks I start off with a couple of shots of vodka with my mates just to get the night going but that's about it." (Year 10 male)
The good news was that no young person reported that they had been provided a bottle of spirits, whether that be vodka, bourbon or whatever, by their parents. Thank heavens for small mercies! But let's break down just how much alcohol some of these teens were actually being provided ...
  • A 6-pack of beer is going to be around 8.2 standard drinks (full-strength - 1.2 per can), around 6 (mid-strength - 1 per can) and 4.2 standard drinks (light - around 0.7 per can). Of course this varies depending on brands (cans and bottles can vary slightly but not too much usually) but realistically that's a lot of alcohol. I also need to say that not one of the young men who said they drank beer admitted to drinking light beer, with one Year 11 saying that that would be 'social suicide'!
  • The number of standard drinks in bourbon and cola UDL cans vary depending on whether they are the 'normal strength' or 'black label' variety. Four of these cans can amount to anywhere from 4.8 to 6 standard drinks if they are the cheaper variety, up to 7.6 for the higher strength versions
  • Four Smirnoff Double Blacks (the most popular drink amongst the girls) results in them consuming 7.6 standard drinks – more than a third of a bottle of vodka!
I firmly believe that most parents who are providing their teens alcohol to take to parties and gatherings are doing so for what they believe are the 'right reasons'. I hear it all the time from parents I meet - "I give it to them because they're going to get it from somewhere and I'd much rather they get it from me - at least I know what they're drinking."

These are parents who truly love their kids - I don't for a minute think they are intentionally trying to put their kids into harm's way. In fact, I think it's just the opposite - they're trying to protect their child. So many of the young people I spoke to said that their parents made it very clear that they didn't want them to drink spirits. Unfortunately they just don't seem to have any clue as to exactly how much alcohol they are actually providing their teens - at least, I hope that is the case. For if there is any parent who truly believes that they're keeping their child safer by providing them with the equivalent of well over a third of a bottle of spirits to take to a party or gathering (because that's what a 6-pack of beer or 4 Smirnoff Double Blacks actually is) we really have a problem!   

Sunday, 9 August 2015

Risky parties and gatherings: What can a parent say to keep their teen as protected as possible?

Recently I was contacted by a parent who had recently attended one of my presentations and was concerned about an event that his son was going to attend. As with many of the emails I receive about concern regarding events, this one also had to do with a post-formal party. As anyone who reads my blog regularly knows, these are events I feel very strongly about and, as I always say, so often the parents who put them on are often completely unaware of the potential risks and the almost impossible position they put other parents into when they make the rules they do. The parent's email read as follows:

"After listening to you speak my wife and I are now struggling with how to deal with our 17 year-old son attending a post-formal party he has been invited to ... We have great problems with the party and its rules around alcohol consumption (the parents hosting have specified those wanting to drink may bring no more than 4 drinks with a note from their parent!). Our son is a non-drinker but of course wants to attend. 18th birthday parties are just about to begin (with similar rules no doubt) and even though we won't allow attendance at every 18th for study reasons the floodgates will be opening and non-attendance at friends' parties is not an option.  At this stage, resistance seems pointless and anti-social.  We aren't willing to make our responsible son suffer the humiliation of non-attendance in a battle against a culture that is so off track. Please, how do you think we should respond to this?  What advice do we give to our son and how do we give it?" 

First off, before anything else - no more than 4 drinks??? Do the parents hosting this event realize how much alcohol that actually is? If one of the girls invited (who could be as young as 16 years-old) brings four Smirnoff Double Blacks (the most popular drink amongst this age group) that means they will be consuming 7.6 standard drinks – more than a third of a bottle of vodka! The Australian drinking guidelines recommends that "for healthy men and women, drinking no more than four standard drinks on a single occasion reduces the risk of alcohol-related injury arising from that occasion" - and that's for adults! No number of drinks is recommended for those under 18 years of age, with the guidelines stating that "not drinking alcohol is the safest option."

Now I'm not an idiot and I realize that 'not drinking alcohol' is not realistic for many young people, but when parents suggest that 4 drinks is an appropriate number for a post-formal event, it really takes a lot of effort for me not to completely lose my cool!

So let's get back to the question the parent is posing ... how can you best deal with keeping your teen as safe as possible when they are attending events that you know are potentially risky? As much as many parents would love to keep their teen locked in their bedroom to keep them protected, you've got to let them out and it is important for them to go to parties and gatherings - that's where they learn to socialise, just like we did when we were teenagers. When they're 14, 15 and even 16, if a parent feels a party is not safe it is entirely appropriate for them to turn around and say that you're not going to let them go. I'm not saying it is always going to be easy but if you feel they could be in potential danger then it's your responsibility to act and do what you feel is necessary. In the final year of high school it gets more difficult, particularly in regards to 18th birthday parties and of course, pre- and post-formal events.

So if you've got to that point where you believe you can no longer prevent your teen from attending what you believe could be a risky party or gathering (as the parent said "resistance seems pointless and anti-social"), what advice should you be giving and how do you start the conversation?

I believe the best way to have the talk is to firstly find a good time for all concerned (according to what I have read lately, late at night, not early in the morning is the time of the day when they are most receptive – I always used to say over dinner but apparently that's not always the best time!) and then sit down with your teen and tell them about your concerns. Ask them to give you 5 minutes without them interrupting and then you will give them an opportunity to do just the same. Use this time to tell them clearly why you think the party is risky? Make sure you don't make value judgments about their friends and their friends' parents, just clearly outline why you are worried about the event. End your little speech by stating that regardless of all of that, you love them and you want them to be happy and have fun with their friends – they can go but you want them to now tell you why you shouldn't be worried … 

In my experience that is the best way to frame it – give them the opportunity (without you interrupting or asking any questions) to explain how they (and their friends) are going to look after themselves. Most of the parents that I have spoken to who have used this strategy have told me that they have been pleasantly surprised by the answer their teen provides … If nothing else, it encourages your teen to really think through exactly what could go wrong and what they would do in an emergency. Once they've given their answer, end the conversation by talking through a couple of things that may contribute to keeping them just a little safer at events that could be potentially dangerous. Some of these could include the following:
  • Give them an 'out' – make sure they know that if they don't want to go to an event they're invited to, you're happy to play the bad guy and do a performance in front of their friends (you'd be surprised how many young people actually don't want to go to some of the events they get invited to or only want to go for a short period of time)
  • Decide on a code word or the like just in case they want to leave but want to save face – they can then call you or send a text secretly and then 5 minutes later you call them (when they're now in front of everyone) and tell them that they have to come home for whatever reason
  • Make sure they understand that they have your permission to call an ambulance if anything goes wrong. They need to call for help and then call you straight afterwards – they have your 100% support in this area
  • Make it clear to them that they can call you at anytime and you will be available on the other end of the phone to pick them up, give advice or whatever. If they're going to call anyone for help, you want it to be you. They need to understand that there will be no judgment made when they call and no questions will be asked ... then! There may be lots of questions the next day - but at the time they call, you won't ask any!
As a parent, you've always got to look for those opportunities to 'allow' your child to do something - it's all well and good to try to protect your child by preventing them taking part in certain activities but at some point you do have to let go ... Don't get me wrong - I'm not talking about letting your 14 or 15 year-old wander off to goodness knows where and of course, if you don't want them to do something, you need to say 'no' and then explain clearly why you have made that decision! But during that final year of high school it is important to look for opportunities, not only to allow them to prove to you that they are now young adults who are better able to look after themselves, but also to have quality conversations about safety and clearly outline to you why you shouldn't be as worried as you are.

Saturday, 1 August 2015

Can 'ice' (or any other drug for that matter) really cause 'superhuman strength'?

There are so many urban myths around drugs and drug use, some that have been around for decades. With the continuing interest in methamphetamine (or 'ice') in this country it is not surprising that some of the media commentary that we see in this area contains some so-called 'facts' that are actually based on urban myths that have been disproved time and time again ... One of the classic drug myths repeated in a number of media stories this week was around the ability of 'ice' to give users 'superhuman strength'.

The myth that certain drugs can have this effect goes back to the late 1970s when there were reports of little old ladies who had used a drug called PCP ('angel dust') and had been able to lift up cars. Over the years US media outlets have reported that the same drug enabled users to break free of metal handcuffs (all stories later proven to be completely untrue). Some may remember the Rodney King story where an African American man was beaten by police officers. When they were indicted for the beating the officers claimed that they believed he was high on PCP and that they had heard about the 'superhuman strength' of PCP suspects.

We don't have PCP in this country but we certainly have ice ... On July 30, the Herald Sun newspaper published a story titled 'Ice scourge madness' and included the following quote:

"The drug is having a dangerous impact on frontline members, making criminals more violent and giving them 'superhuman strength' ... In one instance, seven officers were needed to restrain a suspect high on the drug'"

Earlier in the month the Courier Mail had a story that reported "Indigenous women are loading themselves up with the drug ice to get the “superhuman strength” needed to withstand domestic violence" and earlier in the year the Daily Telegraph published an article about the dangers that paramedics were facing with this user group that began as follows:

"Ice users displaying super strength are threatening the lives of paramedics with one revealing it took 12 people to subdue an out of control addict on the Central Coast. The shocking situation took place at Gosford Hospital recently and the 12 people included strongly built paramedics, police officers and security staff and the user weighed only 60kg."

So is it true? Can methamphetamine (or any other drug for that matter) actually give an otherwise 60kg 'weakling' superhuman strength? Have the comic books been true all along?

Firstly, let me make it very clear that I am not dismissing the reports made by police officers, paramedics and emergency department workers that have to deal with ice users. Methamphetamine users are an extremely difficult and potentially dangerous group to work with and frontline workers, whether they be from the law enforcement or health sectors, face the very real threat of injury when they come into contact with them. But can ice actually increase muscle power and give you 'superhuman' (the term most often used in the media) strength? Science says absolutely not - there are no plausible biological mechanisms to explain how any drug could actually achieve this.

So what is happening? If what the police and paramedics are reporting (one media report quoted police as saying that it took 20 officers to control one person affected by ice) is true and the drug is not supplying the muscle power, how does science explain it?

It would appear that there are potentially two possible forces at play here:
  • the inability to experience pain
  • adrenaline
Essentially strength is limited by physical pain (you only have to look at an Olympic weightlifter's face to see how much pain those people are putting themselves through - trying to push past their personal pain barrier to try and lift just a few kilos more). When we start to experience pain our natural human instinct is to stop doing what we're doing and not go past it. After using methamphetamine, particularly when you have been on a binge and are really flying, you are less likely to experience pain. At the same time, drugs like ice also make you feel like you're strong and powerful (you may feel like you're Superman - particularly if you are psychotic) and so when you put these two things together you have the 'perfect storm'. When faced with situations where people are trying to 'control' them in some way (police trying to arrest them or paramedics attempting to assist them), there is the very real possibility that ice users will lash out, become violent and push their body well beyond their usual limitations. Although it may appear that the person has superhuman strength, it's just that no pain signals are reaching their brain and they push past their pain barrier, far further than any sober person could, often causing significant muscle and tendon damage as a result.

We've all heard stories of people in extreme situations being able to do incredible things, often exhibiting unbelievable strength when faced with potential disaster (e.g., small women lifting small cars off people involved in accidents, hikers hoisting boulders off friends, etc). This temporary burst of physical power is called 'hysterical strength' and is explained by an adrenaline rush. When we are faced with sudden stress and/or imminent danger the human body goes into what is often referred to as the 'fight or flight' response. It's our body's way of preparing for physical harm with adrenalin being released into the bloodstream. Adrenaline is responsible for a range of physical changes that attempt to safeguard us from what is about to happen ... it maximizes breathing capacity, fuels muscles preparing them for action, blood flow to vulnerable extremities is decreased and dopamine is produced in the brain as a natural pain killer. Peripheral vision is lost, turning into tunnel vision in an attempt to minimize distractions and reflexes and reaction times are heightened.

Well to some degree this certainly sounds like superhuman strength ... or does it? There's a great well referenced article by Brian Dunning (2011) where he examines this phenomenon and says that "it's only partly true". The fight or flight response and the adrenaline rush can certainly help exceed normal capabilities, but only to a certain point - it doesn't mean that you have 'super powers'!

I believe that what is happening with these ice users who are demonstrating great strength is a combination of these two factors. Almost all of the stories reported involved police or health workers trying to 'control' the user in some way. These are people who are often experiencing psychosis (they are paranoid and hallucinating) and when approached (particularly by law enforcement) they experience a 'fight or flight' response and a burst of adrenaline. If an attempt is made to restrain them in some way (which is often the case), because of their inability to experience pain, they are able to push past their natural threshold. Did ice give them superhuman strength? Absolutely not! Are they out of control, potentially dangerous and incredibly difficult to deal with? Without a doubt!

Police officers and frontline health workers have an extremely difficult job and put themselves at great risk everyday. I do not want to downplay that in anyway ... that said, when we start to use terms like 'superhuman strength' it plays into the media's hands and feeds into the 'moral panic' that we already have around this issue. If you believe everything you read about this drug you honestly would think that it is some type of 'superdrug' - it causes users to gouge their eyes out and eat them, it rots your teeth, makes you age almost overnight and gives you super strength! Most of these effects are based on an element of truth but have been exaggerated or twisted to make a better story ...

If we take a careful look at why ice users behave the way they do and why it can take 6 police officers to subdue a person under the effect of the drug then perhaps we can learn to respond in a more effective way and ensure the safety of the people working on the frontline. Dunning ends his article with the following quote that I believe says it all ...
"The ability to acquire superpowers, even if only temporarily, is such a compelling possibility that most of us really want these stories to be true. And many of them probably are true to some degree, just exaggerated, misreported, or even misinterpreted by those who were there; and so, sadly, they're not yet the confirmation of superpowers that we're hoping for. It's a really intriguing field of research, and an attractive goal. But it's a goal we'll only reach if we go beyond the popularly reported versions of the stories and take the trouble to learn what's really going on."

Reference: Dunning, B. (2011). Superhuman Strength during a Crisis. Skeptoid Podcast. Skeptoid Media, Inc., 26 Apr 2011. Accessed 1 August, 2015.

About Me

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Paul Dillon has been working in the area of drug education for the past 25 years. Through his own business, Drug and Alcohol Research and Training Australia (DARTA) he has been contracted by many organisations to give regular updates on current drug trends. He has also worked with many school communities to ensure that they have access to good quality information and best practice drug education. His book 'Teenagers, Alcohol and Drugs' was released nationally in February 2009. With a broad knowledge of a range of content areas, Paul regularly appears in the media and is regarded as a key social commentator, with interviews on television programs such as Sunrise, TODAY and The Project.