Additional The National Self-Harm Registry of Ireland compiles an

Additional Information found duringResearchSelf-HarmingOur patienthad visible evidence of previous intentional self-harming with the scars on herabdomen.

She was also causing self-harm through her lifestyle of alcoholism andaddiction to pain medication.Self-Harming,also known as non-suicidal self-injury or is the act of deliberately harmingone’s own body. Most common types of self-harm include cuts and burns. It isnot seen as attempted suicide, but an unhealthy way of dealing with differentpains, emotions or frustrations. (Mayo Clinic Staff, 2017)Injuries arenot 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 guiltfelt afterwards.

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 (Mayo Clinic Staff, 2017)Risk factorsfor self-harm include Life Issues, Mental Health Issues and Excessive Alcoholor drug use (Mayo Clinic Staff, 2017). Self-Harm in IrelandThe NationalSelf-Harm Registry of Ireland compiles an Annual Report. This report iscompiled at the request of the National Suicide Research Foundation (NSRF) andis used to monitor the incidence and repetition of intentional self-harm casespresented the country’s Emergency Departments for the year.

Around 67%of all incidents of self-harm presented to hospitals in Ireland in 2016involved an overdose of medication. Paracetamol-containing medications,antidepressants and mood stabilisers were mostly involved. It was a method morecommonly used in women than men, being in 72% of all Female cases (Griffin, 2017).

On route tothe Emergency Department with our patient, her sister informed us that ourpatient often took excessive amounts of prescribed medications such as Tramadoland Valium. She attended her local Medical practice a couple of times a weeklooking for prescriptions. She complained of having abdominal pain fromGallstones. She frequently changed her GP, when one would refuse to prescribecertain medications that she felt she needed. Her sistertold us that lately she has been calling the local “after hours” GP service”Now Doc” complaining of severe abdominal pain because she finds it easiergetting medication from there.

This is because the doctor on call is generallynot from the area and is unaware of her full history. Effects of Location and Age onSelf-HarmingThestatistics show that 62 females within our patient’s age group (35-44 years)presented to Letterkenny University Hospital in 2016 with intentionalself-harm. This was almost double the number of presentations of every otherage group and significantly higher than the 38 Male presentations aged (35-44years) (Griffin, 2017). This would indicatethat Females within our patient’s age group in Donegal are a much higher riskfactor for self-harming.Looking atthe national figures, Donegal is ranked in the middle when it comes toinstances of self-harm among Females, sitting at the average European agestandardised rate of 230 per 100,000. Cities such as Limerick, Dublin and Corkhave almost double this figure (Griffin, 2017). Alcoholism among Women in IrelandTraditionallyin the misuse of Alcohol and drugs has mainly been associated with men. Howeverin recent times, women have caught up with them.

This was discovered from globalresearch carried out by the National Drug and Alcohol Research Centre of theUniversity of New South Wales, Australia that looked at the consumption habitsof 4 million people. They put the increase of women’s drinking down to targetmarketing, the availability of low cost wine and beer in Supermarkets and poordrinking cultures (Sarah Boseley, 2016).One in 4Irish Women experience harm due to their own alcohol abuse (Mongan, 2013). Women are morelikely than men to suffer adverse effects on their physical health as result ofalcohol and drug misuse. Up to 12% of all Breast Cancer diagnoses in Irelandare associated with alcohol consumption. Drinking one alcoholic drink a day hasa 9% increase in the risk of developing breast cancer, while having 3-6 drinksa day increases the risk by 41%. (Alcohol Ireland Staff, 2017).

Women can alsodevelop liver diseases such as Cirrhosis and Hepatitis in a shorter period oftime at lower levels of alcohol intake. (Womens Health Council Ireland, 2008)   Effects of Alcoholism on familiesAlcoholismcan have a severe impact on a family unit. It is known as a family diseasebecause of the disruption it causes to family life and its harmful effects thatcan last a lifetime (Heffner,2003). Our patient was previously in a long term relationship and had adaughter to her partner. This relationship has since broken up and she rarelysees her child. Children wholive with a father and/or mother who is an alcoholic are known to experienceeffects that include:Lowself-esteemFeelingsof Guilt and despairLonelinessand fear of abandonmentChronicDepressionHighLevels of Anxiety and StressChildrenhave these traits, as they believe their parents’ drinking is their fault. Asthey get older, they tend to find it more difficult to make friends andestablish relationships. Through the effects they experience, they feel differentthan their peers and can carry this image of themselves throughout their lives.

Children in alcoholic families are also more susceptible to neglect and childabuse (Heffner, 2003).Alcoholism also has poor affectamongst spouses/partners of Alcoholics (Parsons, 2003).. Our patientis back living at home with her father.

She has three elder siblings. Hersister who travelled to the hospital with us said that they have all but givenup on her. She told me that over the years, they have exhausted every avenuetrying their best to support her and get help for her, but our patient was notwilling to change her habits long term and help herself. Ourpatient’s sister said that her alcoholism and reckless lifestyle reallyaffected their mother who passed away earlier in the year as she was alwaysworrying about her youngest child. I got the impression that there was a bit ofresentment towards our patient for that. Impact of Alcohol on the Health ServiceAround €1.

5Billion is spent on alcohol related in-patient hospital stays in Ireland eachyear. This is around 10% of the total HSE budget. These costs don’t include GPvisits, psychiatric visits and alcohol treatment services. In 2013 this equatedto 160,211 bed days; 3.6% of all bed stays that year (Health Service Executive, 2015).  Services Available to People withAddiction issuesLocal HSEoffices provide addiction services funded by the Department of Health. In recentyears, there are also an increasing number of private organisations offeringhelp to those trying to combat the effects of addiction.Treatmentsfor addiction differ and can be given in a residential or non-residentialsetting.

It depends on the patient’s circumstances and personal preferences (Citizens Information, 2016). Non-residential treatments include:AddictionCounselling- begins with assessment, and information on treatment services.Patients are then advised on the best type of counselling to suit them (groupor individual counselling). Detoxification-Removing the physical craving for alcohol with prescribed anti-anxiety drugs.

Detoxification does not deal with the psychological factors of addiction; thismust be done through counsellingMedication-Prescribed medication can be used in the initial stages of treatment. This isknown as pharmacotherapy; they are used to counter the neurobehavioralmechanisms that initiate and maintain alcohol use (Dr. Robert M. Swift, 2016).

ResidentialProgrammes- used to take the patient away from their usual environment, weenthem away from their addiction and begin therapy.GroupSupport- Group meetings, such as Alcoholics Anonymous take place weekly in mosttowns around the country. They are generally free of charge (Citizens Information, 2016)Ourpatient’s sister told us that with her family’s support, she used all addictionservices available to her over the years both public and private. Some workedfor a while, but none helped her get over her issues on a long term basis.        ConclusionOur patient previouslylived a normal life.

She had travelled the world and lived in Australia for anumber of years. After moving home 10 years ago, she began to suffer from addictionproblems and depression. She was in a relationship and had a young daughter. In the pastcouple of years her addiction to alcohol and medications has worsened and hermental health has deteriorated.

She is no longer in a relationship and rarelysees her daughter, who lives with her ex-partner. She has been unemployed forthe past number of years and now lives at home with her elderly father, in whatappeared to be poor conditions.Our patienthas three older siblings that have tried to support her and help her with herdifficulties, but feel it’s a waste of time as the patient isn’t willing tohelp herself. They feel that they have exhausted all avenues. They have busylives and families of their own. Her mother passed away a couple of monthspreviously and her situation appears to have worsened since then.The factthat our patient is estranged from her partner and rarely sees her child mostlikely contributes to her poor mental state; causing feelings of guilt, regret,low self-esteem, hopelessness and other depressive traits.

This in turn makesher drink more and abuse medications, causing a vicious circle.On follow upin the Emergency Department I was informed that the patient was treated foralcohol poisoning, but she discharged herself later that evening. Our patientis a young woman with a lot to live for. However without a change in herlifestyle and the will to help herself, I fear an ominous outcome for her.          ReferencesAlcohol Ireland Staff, 2017. Alcohol Facts.

OnlineAvailable at: 17 01 2018.CitizensInformation, 2016. Alcohol addiction treatment services. Online Available at: http://www.citizensinformation.

ie/en/health/health_services/alcohol_and_drug_treatment_services/alcohol_addiction_services.htmlAccessed 20 01 2018.Dr. Robert M.Swift, D. E.

R. A., 2016. Pharmacotherapy for Alcohol Use Disorder: Currentand Emerging Therapies. Online Available at: https://www.ncbi.nlm.nih.

gov/pmc/articles/PMC4790835/Accessed 20 01 2018.Griffin, E. D.C. A. E.

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L., 2003. Alcoholism and Its Effect on the Family. Online Available at: http://allpsych.

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com/alcohol/body-temperature-hypothermia-hyperthermia.htmlAccessed 17 01 2018.Parsons, T.,2003. Alcoholism and Its Effect on the Family. Online Available at: 20 01 2018.PHECC, 2014.

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Sarah Boseley,L. C., 2016. Women drinking as much alcohol as men, study finds.

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Womens HealthCouncil Ireland, 2008. Women & Substance misuse in Ireland. OnlineAvailable at: 18 01 2018.