Monthly Archives: August 2017

Alcohol by the Numbers – Thoughts on the Alcohol Harm in Canada Report

f28df-1445359631870This headline made the news this summer: Alcohol leads to more hospitalizations than heart attacks do in Canada. The report by the Canadian Institute for Health Information outlines alcohol use across Canada and identifies population at risk of harm by alcohol. They released this infographic and the facts below:

 

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I thought I would take an FASD prevention lens to some of the report findings… 

1. One of the questions addressed in the CIHI report was whether health practitioners are asking Canadians about their alcohol use. They reported “25% of males and 22% of females reported having talked about alcohol use with a health care provider in the past 2 years. For both males and females, Alberta had the highest reported rates of talking about alcohol use with a care provider.” These conversations are important because they can increase awareness among women of child-bearing age and their partners about the effects of drinking during pregnancy before they become pregnant. Our colleagues at the Girls, Women, Alcohol, and Pregnancy: Perspectives on FASD Prevention blog shared various resources and campaigns to promote conversations on alcohol between women and their healthcare professionals.

2. The report also noted hospitalizations caused entirely by alcohol among children and youth:

“The most common diagnoses for hospitalizations entirely caused by alcohol for children and youth age 10 to 19 were harmful alcohol use and alcohol intoxication (results not shown). Girls age 10 to 19 are more frequently hospitalized for alcohol than boys in this age group; this is the only period throughout the lifespan where hospitalizations entirely caused by alcohol among females outnumber those among males.”

In addition, they reference a study about binge drinking and associated health risk behaviours among high school students that suggests:

“Students who binge drank were more likely than both nondrinkers and current drinkers who did not binge to report poor school performance and involvement in other health risk behaviors such as riding with a driver who had been drinking, being currently sexually active, smoking cigarettes or cigars, being a victim of dating violence, attempting suicide, and using illicit drugs.”

Interventions for reducing alcohol-exposed pregnancies in youth include Project CHOICES. Support professionals can find information and training materials for this intervention here.

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3. CanFASD believes that terms like low, moderate, and heavy can be confusing and subjective, and when we use them in messages about how much alcohol can be safely consumed by pregnant women they perpetuate controversy and confusion.

CIHI defined heavy drinking as having 5 or more drinks for men and 4 or more drinks for women on 1 occasion at least once a month over a 1-year period. Here’s a brochure by the Canadian Centre on Substance Abuse outlining Low-Risk Alcohol Guidelines. Also, Rethink Your Drinking created a video about the Low-Risk Alcohol Drinking Guidelines. I’m pleased to see both of these resources use the language of Zero is the Limit for women who are pregnant or hoping to become pregnant.

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Women who drink during pregnancy at greater risk to die by suicide: study

Infectious diseases A-Z: babies born with Zika-related birth defects

Women who drink during pregnancy and give birth to children who have fetal alcohol spectrum disorder are more likely to attempt and die by suicide, a University of Manitoba study has found.

It is the first Canadian study to look at health data in relation to the prevalence of suicide among mothers whose children have FASD. The report was recently published in the Canadian Medical Association Journal.

“The common perception of women who drink alcohol during pregnancy is that they have failed society,” said Deepa Singal, a PhD candidate at the U of M and lead author of the study. “However, the increased rate of suicide among these mothers shows how society may be failing them.”

FASD is a neurodevelopmental disorder that can occur when a baby is exposed to alcohol in the womb. It can have lifelong effects that include physical, mental, behavioural and learning disabilities.

Researchers analyzed anonymous data stored at the U of M to trace the health history of mothers whose children had FASD and compared it to mothers whose children did not.

They found mothers of children with FASD are more prone to both suicide attempts and death by suicide. The study also found they are more likely to be poor, single parents and suffer from mental disorders.

“Identifying groups of women who are at risk for suicidal behaviour is crucial for developing effective suicide-prevention strategies,” Singal said.

Data from 700 mothers whose children had FASD was analyzed and compared with data from 2,100 mothers whose children did not. The data used traced the mothers’ medical history from 1979 to 2013.

Although researchers expected to find mothers of children with FASD had higher rates of suicide attempts during pregnancy and during the first year of the child’s life, this did not prove true; instead, they found the mothers were at an increased risk of suicide later in life.

The mothers whose children had FASD did show higher rates of prenatal and postpartum psychological distress, researchers said.

The findings point to a need to identify women at a high risk to drink during pregnancy and screen them for suicidal behaviour and mental disorders, according to Singal.

She said it highlights the need to provide mental-health services for women who drank during pregnancy to prevent suicide later in life.

“Pregnant women don’t drink to intentionally harm the unborn baby. They likely consume alcohol to cope with stressful life circumstances and addiction, or they may not realize they are pregnant,” Singal said.

Retrieved from: https://www.winnipegfreepress.com/local/women-who-drink-during-pregnancy-at-greater-risk-to-die-by-suicide-study-441666703.html

More Women Than We Thought Have Babies With Fetal Alcohol Spectrum Disorder: You might want to rethink that drink

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Drinking while pregnant could be doing more harm than anyone has previously believed. According to Toronto’s Centre for Addiction and Mental Health (CAMH), one in every 13 women who consumes alcohol while expecting will have a baby born with fetal alcohol spectrum disorder (FASD).

CAMH’s findings, which were published in JAMA Pediatrics on Monday, analyzed 24 existing studies of more than 1,400 children to determine how prevalent FASD is in kids aged 0 to 16 around the world. Globally, they found that nearly eight in 1,000 babies are born with the disorder.

“FASD prevalence estimates are essential to effectively prioritize and plan health care for children with FASD, who are often misdiagnosed,” said Dr. Svetlana Popova, Senior Scientist at CAMH’s Institute for Mental Health Policy Research. “Most of these children will require lifelong care, so the earlier they have access to appropriate therapy and supports, the better their long-term health and social outcomes will be.”

FASD is considered a brain injury and a lifelong disorder.

Fetal alcohol spectrum disorder is a blanket term for all the problems that can happen to an infant when a mother drinks during pregnancy. This includes the commonly heard fetal alcohol syndrome, which can cause a baby to have central nervous system disorders, growth problems, and abnormal facial features, among other things, according to Baby Center Canada.

FASD is considered a brain injury and a lifelong disorder, since it may not only affect a child’s physical abilities but mental, behavioural and learning abilities as well.

According to the CDC and the U.S. Surgeon General, “There is no known safe amount of alcohol to drink while pregnant. There is also no known safe time during pregnancy or safe type of alcohol.”

 

The analysis done by CAMH determined how common FASD is for children in each country. While it was estimated that there are eight FASD cases for every 1,000 Canadian children, rates are higher in the U.S., with 15 cases for every 1,000 children. Additionally, the European region has nearly 20 per 1,000.

According to the study, children from low-income communities, foster care, psychiatric care, the criminal justice system, and the Aboriginal community were more likely to suffer from FASD.

There are eight FASD cases for every 1,000 Canadian children.

“The findings highlight the need to establish a universal public health message about the potential harm of prenatal alcohol exposure and a routine screening protocol,” the study concluded. “Brief interventions should be provided, where appropriate.”

Dr. Popova also noted that more attention needs to be paid to communities who are at an increased risk.

“There is a need for targeted screening and diagnosis for these high-risk populations, as well as interventions to prevent alcohol use among mothers of children with FASD in relation to subsequent pregnancies,” she said.

By: Isabelle Khoo
Retrieved from: http://www.huffingtonpost.ca/2017/08/23/fetal-alcohol-spectrum-disorder_a_23158640/

With Heavy Drinking On The Rise, How Much Is Too Much?

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Binge-drinking sounds like an all-night bender, but here’s a reality check: Many social drinkers may “binge” without knowing it. Women who drink four or more drinks on an occasion are binge-drinking.

If one glass of wine takes the edge off, why not drink a few more?

This thinking may help explain the findings of a new study that points to an increase in drinking among adults in the U.S., especially women.

“We found that both alcohol use and high-risk drinking, which is sometimes called binge-drinking, increased over time,” says Deborah Hasin, a professor of epidemiology at the Columbia University Medical Center and an author of the study.

To assess drinking trends, researchers conducted face-to-face interviews with thousands of adults. Researchers asked a series of questions, such as: Did you ever drink four or more drinks on an occasion, and if so, how often? The study compares the findings from two surveys. One was carried out in 2001-2002; the other was from 2012-2013.

So what’s behind the increase? The study wasn’t designed to answer this question, but Hasin says there could be a combination of factors.

“Increasing numbers of people feel pessimistic about their economic chances,” she says. So this might help explain the increase in drinking among low-income Americans. As we’ve reported, economists have linked the economy to so-called deaths of despair from causes including opioid overdoses and alcohol abuse.

When it comes to explaining the increase found among women, the way alcohol is marketed may play a role, too. Hasin says she is speculating here, “but just looking at display windows in liquor stores,” they seem designed to appeal to women. “Everything is pink, it’s all rose,” she says.

And beer-makers have sharpened their pitch to female drinkers too, as this Advertising Age article points out. A recent campaign for Coors Light features women competing in races and climbing mountains. “Every climb deserves a refreshing finish,” the ad’s narrator intones.

So if the makers of wine, beer and spirits are enticing us to drink, are some of us ignoring the risks of excessive drinking? Or maybe many women don’t realize when they’re drinking too much?

Not all national surveys have pointed to an increase in drinking. In fact, the National Survey on Drug Use and Health found a slight decline in alcohol use disorders between 2002 and 2013. But even if there’s been no increase, public health experts say excessive alcohol consumption has long been a problem in the U.S.

“Excessive alcohol use is a huge public health problem in the United States,” says physician Bob Brewer, who leads the alcohol program at the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention. The CDC estimates that there are about 88,000 deaths due to excessive alcohol use in the U.S. each year.

“Ninety percent of people in the U.S. who drink to excess are binge-drinking,” Brewer says.

Binge-drinking, to me, always sounds like a term for an all-night bender. But here’s the reality check: It’s easier to “binge” than you might think.

The definition of binge-drinking is “four or more drinks for a woman on an occasion, five or more for a man,” Brewer explains.

So think of an evening out: Perhaps you start with a cocktail, then add beer or wine with dinner. The drinks can add up faster than you think.

“It can be tricky sometimes for people to really keep track of the number of drinks they’re consuming,” Brewer says.

A 5-ounce serving of wine counts as one drink. And a 1.5-ounce shot of spirits (such as vodka, gin, or bourbon) counts as a drink, too. But often, cocktails contain more than one shot. (Exactly what counts as “a drink” is detailed here.)

“A lot of beers now, particularly craft beers, may have higher alcohol content,” Brewer says. “So, if you have a 12-ounce beer that [contains] 9 percent alcohol, you’re really drinking the equivalent of close to two drinks,” Brewer says.

There are tips to help you guard against drinking too much, especially at a festive event or social gathering, such as an office party. One tip: Make a pact with yourself or with somebody else to take a break before each drink. And another: Alternate between glasses of water and alcohol.

Brewer says it’s worth reminding everyone that the U.S. Dietary Guidelines recommend that women limit alcohol to one drink per day, two for men.

Retrieved from: http://www.npr.org/sections/thesalt/2017/08/16/543965637/women-who-love-wine-are-you-binge-drinking-without-realizing-it?utm_campaign=storyshare&utm_source=twitter.com&utm_medium=social

Provincial grant aims to empower women in Calgary

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Hazel Kikot plays with her 11-month-old son Haiden during an event at Sunalta Community Centre. Kikot is part of Connections Counselling and Consulting Foundation, which received a $34,000 grant from the province. (Mike Symington/CBC)

Life hasn’t always been easy for single mom Hazel Kikot, who suffers from fetal alcohol syndrome.

But the Connections Counselling and Consulting Foundation in Calgary has given her something she was missing.

“I just felt a part of something which I’ve never really had before,” Kikot told CBC News Sunday.

That feeling made her eager to participate in the foundation’s Brand New Me workshop series, designed to aid women with disabilities who have experienced violence, lack personal confidence or need help with life skills.

The workshops help women develop social and boundary-setting skills, build self-confidence and also include sexual health education, employment preparation and tools to address abusive relationships.

“In school I’ve always struggled so with Connections, it’s more hands-on and they’ve shown me and walked me through it and always are positive, they give positive vibes,” Kikot said.

$34K grant from province

On Sunday, the Alberta Ministry of Status of Women announced a $34,000 grant for the foundation during a gathering at the Sunalta Community Centre.

For foundation director Erin Waite, the money means being able to offer the program to more who need it.

Connections Counselling and Consulting Foundation Hazel Kikot

Hazel Kikot credits the foundation with improving her own self-esteem. (Mike Symington/CBC)

“A big factor in their lives is isolation,” she said. “And so what happens is, they’ve faced the stigma of disability all their lives and because of that they don’t participate in community events, even when it’s made available to them.”

Some of the money will be used to fund transportation and daycare services, which Waite said are often barriers to participation.

“This kind of programming really ensures that portions of our population that are being left out get to participate, which makes a big difference,” Waite said.

The workshops run until January 2018.

Retrieved from: http://www.cbc.ca/news/canada/calgary/calgary-connections-counselling-consulting-foundation-1.4255158

Australia: Call to Combat Fetal Alcohol Spectrum Disorder

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Rates of Fetal Alcohol Spectrum Disorder among Australian Aboriginal children are up to 12 times higher than a newly-determined universal average that has triggered concern among experts.

Almost one in every 100 children worldwide suffer from the condition, which is caused by consumption of alcohol during pregnancy, according to research published in the journal JAMA Pediatrics.

The findings have sparked calls for greater intervention to cut the rates across the globe.

“The findings highlight the need to establish a universal public health message about the potential harm of prenatal alcohol exposure and a routine screening protocol. Brief interventions should be provided, where appropriate,” the authors conclude.

Addiction and mental health researchers in Canada conducted a meta-analysis of 24 studies including 1416 children and youth diagnosed with FASD.

Several Australian studies were included, among them a 2015 examination of an Indigenous Australian population which found 12 of every hundred children had the disorder.

One of every 13 women who consumed alcohol while pregnant was estimated to deliver a child with FASD, according to the analysis.

Meanwhile, a University of Sydney study initiated by concerned Aboriginal community leaders earlier this year revealed children with FASD are more likely to fail at school, have attention problems and talk about suicide.

The findings, reported in the Journal of Development and Behavioural Pediatrics, were based on surveys of parents and teachers of primary school Aboriginal Australian children living in remote communities in Fitzroy Valley, Western Australia.

Within the Fitzroy Valley study population, 55 per cent of mothers reported drinking alcohol during pregnancy and of these, 87 per cent drank at high levels. All but two of the assessed children were Aboriginal.

“These findings highlight the need for support for families, carers, and teachers to handle the behavioural and mental health problems in children with FASD,” said the study’s lead author, Dr Tracey Tsang of the University of Sydney.

“This is particularly challenging in remote and disadvantaged communities,” said Dr Tsang.

Sydney University’s Professor Elizabeth Elliott said in addition to difficult behaviours, children with FASD have learning, developmental and physical problems.

“FASD is preventable and we must educate young women about the harms of alcohol use in pregnancy,” Prof Elliott urged.

Retrieved from: http://www.sbs.com.au/news/article/2017/08/22/call-combat-fetal-alcohol-syndrome

Housing is a key component to women’s recovery

1cyrqyw0ccktv906f9sp_400x400Sheway is well-known in Canada for its success in providing wrap-around services for pregnant and newly parenting women who are dealing with complex personal and social circumstances. It is trauma-informed, women-centred, culturally responsive and uses a harm reduction approach with a focus on connection with self and others. Women and their children can remain in the program up to 18 months post-partum. Last December, Lenora Marcellus, University of Victoria, and Sheway published findings to their study on how women make the transition from Sheway to living on their own – Supporting Families at Sheway and Beyond. Additionally, Dr. Marcellus has published a journal article:

Marcellus, L. (2017). A grounded theory of mothering in the early years for women recovering from substance use. Journal of Family Nursing. E-print ahead of press. 

In order to learn what elements of a positive transition could be identified and built upon, they followed 18 women for 3 years after leaving Sheway. These women faced multiple obstacles in this transition process with the overarching theme being “holding it together.” Their daily efforts are explored in these 3 ways:

Restoring Self: gaining recovery and taking care of self, reconnecting with self and others, and rebuilding trust and credibility.

Centering Family: parenting their children, preserving a routine, dealing with partners, and handling custody issues.

Creating  Home: “chasing housing”, having to take whatever housing is available even if inadequate, and maintaining not only a physical space but a feeling of home for the family

While acknowledging the value for pregnancy and postpartum support as most often provided in maternity programs, their findings underscore that secure housing is a key component to a successful transition for women and their families. Yet, although housing is important to the overall health of women and their families, the choices they must make often result in a double bind. For example, women often are faced with choosing between affordable housing that is far from supports versus more expensive housing that is near supports. Some women must choose between staying in an unsafe relationship or losing housing. As well, some women must accept inadequate housing because of their substance use history, which serves to undermine their recovery and their maintaining custody of their children.

“Poor housing was identified by women as a potential trigger to relapse in their recovery.” – [1] p. 39

Complete findings are detailed within the report and recommendations are framed within the Levels of Prevention model developed by this prevention network.  Among the research team recommendations is to extend the time women can stay in the program in order to solidify recovery, supports and resources. As well, they stress that housing needs to be a core component of intensive, integrated maternity programs.


For more on these topics, see earlier posts:

HOLISTIC AND SPECIALIZED SUPPORT FOR PREGNANT WOMEN: LEVEL 3 PREVENTION, November 21, 2016
THE MOTHER-CHILD STUDY: EVALUATING TREATMENTS FOR SUBSTANCE-USING WOMEN, MARCH 18, 2015
SUPPORTING PREGNANT AND PARENTING WOMEN WHO USE SUBSTANCES: WHAT COMMUNITIES ARE DOING TO HELP, OCTOBER 1, 2012
HERWAY HOME ‘ONE-STOP ACCESS’ PROGRAM IN VICTORIA SET TO OPEN, MAY 20, 2012
“NEW CHOICES” FOR PREGNANT AND PARENTING WOMEN WITH ADDICTIONS, JANUARY 9, 2012
TORONTO CENTRE FOR SUBSTANCE USE IN PREGNANCY (T-CUP), DECEMBER 19, 2011
CLINICAL WEBCAST ON BREAKING THE CYCLE PROGRAM: SEPTEMBER 20, 2011, AUGUST 2, 2011

  1. Marcellus, L., Supporting families at Sheway and beyond: Self, recovery, family home. 2016, Sheway: Vancouver, BC.

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