Additional sister told us that lately she

Additional Information found during


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Our patient
had visible evidence of previous intentional self-harming with the scars on her
abdomen. She was also causing self-harm through her lifestyle of alcoholism and
addiction to pain medication.

also known as non-suicidal self-injury or is the act of deliberately harming
one’s own body. Most common types of self-harm include cuts and burns. It is
not seen as attempted suicide, but an unhealthy way of dealing with different
pains, emotions or frustrations. (Mayo Clinic Staff, 2017)

Injuries are
not usually life threatening, as that is not the intention of the patient,
however if left untreated they can become more serious and possibly fatal.
Patients may not always seek medical attention because of the shame or guilt
felt afterwards. (Mayo Clinic Staff, 2017)

Risk factors
for self-harm include Life Issues, Mental Health Issues and Excessive Alcohol
or drug use (Mayo Clinic Staff, 2017).


Self-Harm in Ireland

The National
Self-Harm Registry of Ireland compiles an Annual Report. This report is
compiled at the request of the National Suicide Research Foundation (NSRF) and
is used to monitor the incidence and repetition of intentional self-harm cases
presented the country’s Emergency Departments for the year.

Around 67%
of all incidents of self-harm presented to hospitals in Ireland in 2016
involved an overdose of medication. Paracetamol-containing medications,
antidepressants and mood stabilisers were mostly involved. It was a method more
commonly used in women than men, being in 72% of all Female cases (Griffin,

On route to
the Emergency Department with our patient, her sister informed us that our
patient often took excessive amounts of prescribed medications such as Tramadol
and Valium. She attended her local Medical practice a couple of times a week
looking for prescriptions. She complained of having abdominal pain from
Gallstones. She frequently changed her GP, when one would refuse to prescribe
certain medications that she felt she needed.

Her sister
told us that lately she has been calling the local “after hours” GP service
“Now Doc” complaining of severe abdominal pain because she finds it easier
getting medication from there. This is because the doctor on call is generally
not from the area and is unaware of her full history.


Effects of Location and Age on

statistics show that 62 females within our patient’s age group (35-44 years)
presented to Letterkenny University Hospital in 2016 with intentional
self-harm. This was almost double the number of presentations of every other
age group and significantly higher than the 38 Male presentations aged (35-44
years) (Griffin, 2017). This would indicate
that Females within our patient’s age group in Donegal are a much higher risk
factor for self-harming.

Looking at
the national figures, Donegal is ranked in the middle when it comes to
instances of self-harm among Females, sitting at the average European age
standardised rate of 230 per 100,000. Cities such as Limerick, Dublin and Cork
have almost double this figure (Griffin, 2017).


Alcoholism among Women in Ireland

in the misuse of Alcohol and drugs has mainly been associated with men. However
in recent times, women have caught up with them. This was discovered from global
research carried out by the National Drug and Alcohol Research Centre of the
University of New South Wales, Australia that looked at the consumption habits
of 4 million people. They put the increase of women’s drinking down to target
marketing, the availability of low cost wine and beer in Supermarkets and poor
drinking cultures (Sarah Boseley, 2016).

One in 4
Irish Women experience harm due to their own alcohol abuse (Mongan, 2013). Women are more
likely than men to suffer adverse effects on their physical health as result of
alcohol and drug misuse. Up to 12% of all Breast Cancer diagnoses in Ireland
are associated with alcohol consumption. Drinking one alcoholic drink a day has
a 9% increase in the risk of developing breast cancer, while having 3-6 drinks
a day increases the risk by 41%. (Alcohol Ireland Staff, 2017). Women can also
develop liver diseases such as Cirrhosis and Hepatitis in a shorter period of
time at lower levels of alcohol intake. (Womens Health Council Ireland,




Effects of Alcoholism on families

can have a severe impact on a family unit. It is known as a family disease
because of the disruption it causes to family life and its harmful effects that
can last a lifetime (Heffner,
2003). Our patient was previously in a long term relationship and had a
daughter to her partner. This relationship has since broken up and she rarely
sees her child.


Children who
live with a father and/or mother who is an alcoholic are known to experience
effects that include:

of Guilt and despairLoneliness
and fear of abandonmentChronic
Levels of Anxiety and Stress

have these traits, as they believe their parents’ drinking is their fault. As
they get older, they tend to find it more difficult to make friends and
establish relationships. Through the effects they experience, they feel different
than their peers and can carry this image of themselves throughout their lives.
Children in alcoholic families are also more susceptible to neglect and child
abuse (Heffner, 2003).
Alcoholism also has poor affect
amongst spouses/partners of Alcoholics.

Our patient
is back living at home with her father. She has three elder siblings. Her
sister who travelled to the hospital with us said that they have all but given
up on her. She told me that over the years, they have exhausted every avenue
trying their best to support her and get help for her, but our patient was not
willing to change her habits long term and help herself.

patient’s sister said that her alcoholism and reckless lifestyle really
affected their mother who passed away earlier in the year as she was always
worrying about her youngest child. I got the impression that there was a bit of
resentment towards our patient for that.


Impact of Alcohol on the Health Service

Around €1.5
Billion is spent on alcohol related in-patient hospital stays in Ireland each
year. This is around 10% of the total HSE budget. These costs don’t include GP
visits, psychiatric visits and alcohol treatment services. In 2013 this equated
to 160,211 bed days; 3.6% of all bed stays that year (Health
Service Executive, 2015).


Services Available to People with
Addiction issues

Local HSE
offices provide addiction services funded by the Department of Health. In recent
years, there are also an increasing number of private organisations offering
help to those trying to combat the effects of addiction.

for addiction differ and can be given in a residential or non-residential
setting. It depends on the patient’s circumstances and personal preferences (Citizens Information, 2016).

residential treatments include:

Counselling- begins with assessment, and information on treatment services.
Patients are then advised on the best type of counselling to suit them (group
or individual counselling). Detoxification-
Removing the physical craving for alcohol with prescribed anti-anxiety drugs.
Detoxification does not deal with the psychological factors of addiction; this
must be done through counsellingMedication-
Prescribed medication can be used in the initial stages of treatment. This is
known as pharmacotherapy; they are used to counter the neurobehavioral
mechanisms that initiate and maintain alcohol use (Dr. Robert M.
Swift, 2016).Residential
Programmes- used to take the patient away from their usual environment, ween
them away from their addiction and begin therapy.Group
Support- Group meetings, such as Alcoholics Anonymous take place weekly in most
towns around the country. They are generally free of charge.

patient’s sister told us that with her family’s support, she used all addiction
services available to her over the years both public and private. Some worked
for a while, but none helped her get over her issues on a long term basis.










Our patient previously
lived a normal life. She had travelled the world and lived in Australia for a
number of years. After moving home 10 years ago, she began to suffer from addiction
problems and depression. She was in a relationship and had a young daughter.

In the past
couple of years her addiction to alcohol and medications has worsened and her
mental health has deteriorated. She is no longer in a relationship and rarely
sees her daughter, who lives with her ex-partner. She has been unemployed for
the past number of years and now lives at home with her elderly father, in what
appeared to be poor conditions.

Our patient
has three older siblings that have tried to support her and help her with her
difficulties, but feel it’s a waste of time as the patient isn’t willing to
help herself. They feel that they have exhausted all avenues. They have busy
lives and families of their own. Her mother passed away a couple of months
previously and her situation appears to have worsened since then.

The fact
that our patient is estranged from her partner and rarely sees her child most
likely contributes to her poor mental state; causing feelings of guilt, regret,
low self-esteem, hopelessness and other depressive traits. This in turn makes
her drink more and abuse medications, causing a vicious circle.

On follow up
in the Emergency Department I was informed that the patient was treated for
alcohol poisoning, but she discharged herself later that evening. Our patient
is a young woman with a lot to live for. However without a change in her
lifestyle and the will to help herself, I fear an ominous outcome for her.












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Dr. Robert M. Swift, D.
E. R. A., 2016. Pharmacotherapy for Alcohol Use Disorder: Current and
Emerging Therapies. Online
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Executive, 2015. HSE Policy on Public Health Information Initiatives related
to Alcohol. Online
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Accessed 17 01 2018.

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2016. Women drinking as much alcohol as men, study finds. Online
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Accessed 19 01 2018.

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Accessed 18 01 2018.