FAQ

The signs of alcohol poisoning are similar to other poisoning symptoms: very intoxicated, nausea, unconsciousness. There is enough alcohol in their blood and no other reasons can be found upon examination.

Alcohol has a paralysing effect on the system. A small amount of alcohol first paralyses inhibitions, which relaxes many people and makes it easier for them to socialise. A larger amount has a greater paralysing effect which may be manifested in decreasing ability to think, speak and control one’s balance and movements. Nausea and vomiting may be signs that alcohol poisoning is imminent and the body is trying to get rid of the alcohol in the stomach. In alcohol poisoning the paralysing effects of alcohol are so great that the person is no longer capable of taking care of him/herself and may become unconscious. Similar symptoms may appear also in connection with other poisonings, head injuries, diabetes or serious infections.

If you can wake up the person who you suspect is suffering from alcohol poisoning, you should ask them directly what they have been drinking (or using) and how much. Sometimes you can get this information from the person’s companion or friend. You cannot know based on the symptoms alone whether the person is suffering from alcohol poisoning. As alcohol poisoning is a life-threatening condition, you should not hesitate to contact a health centre or call the emergency number to ask what measures should be taken.

An acute pancreatitis usually begins with severe pain of the upper abdomen, with the pain possibly also radiating to the back. Nausea and vomiting may occur. Sometimes, a sudden deterioration in the general condition after large-scale or long-term alcohol use may be a sign of pancreatitis. There is also a recurring or chronic form of pancreatitis that manifests itself in recurring upper abdominal pains and diarrhoea. Years later this may lead to steatorrhea, weight loss and diabetes. The most common cause of pancreatitis in Finland is alcohol use.

There are many kinds of liver readings. The most common tests are ALAT, ASAT and GT. Only one of these readings or all of them may be elevated. What exactly is considered a normal liver reading depends on the laboratory. As a general rule, readings under 50 are normal for women and readings under 60 normal for men.

Cirrhosis of the liver may in its early stages be without symptoms. When the disease is advanced, it may cause fatigue, jaundice of the skin and eyes and swelling of the abdomen. Alcohol induced inflammation of the liver may precede cirrhosis. The symptoms of the inflammation include abdominal pains, jaundice of the skin and eyes and itching of the skin.

Several different medicines and/or medicine groups are used for depression treatment in Finland. Some of these medications are incompatible with alcohol, while others have even been studied to see if they could be used to treat alcohol addiction. Based on these studies, you can use alcohol if the medicinal substance in your medication is fluoxetine or citalopram. However, if you are being treated for depression, alcohol use cannot be recommended. The use of alcohol may lead to increased depression and panic symptoms, as well as, increase the risk of suicide.

I’m feeling bad about my alcohol use. I should probably be the happiest person on earth. I have two wonderful children, aged 6 months and 3 years, and a good husband. But for some reason I just feel so empty. We argue very easily and I feel like I have to take time off to relax. Usually this means that I meet my friends 2 – 6 times a month for a night out. The night passes merrily and almost always I drink too much, i.e. I can’t remember much. My husband has no understanding for such things. He thinks I would not have a problem if I simply decided not to drink.

Does my alcohol use harm my children? I want to be a good mother and I love my children very much, but I don’t always have the energy for it all. What could I do about my drinking? I don’t think I’m an alcoholic, at least not yet. I already feel horrible and very guilty. I would like to change but don’t know how.

The Answer:
Your two children are still very young so it is no wonder that you feel tired and bored; life seems to consist of nothing more than cooking and taking care of the children. Often the situation is made worse by the fact that men and husbands do not realise that the mother is exhausted and frustrated. When you are tired, even small, insignificant things may lead to arguments.

It would be a good idea to discuss matters with your husband and try to arrange time for yourself and your hobbies a few nights every week. It is also essential that you and your husband can sometimes spend time together without the children and thereby take care of your relationship.

You also wonder about your alcohol use and its effect on your children. Occasional nights out shouldn’t have any effect on the children, if someone they know and feel safe with is taking care of them. I got the impression from your question that you do not drink at home but at restaurants etc., so your children do not need to see your drinking. Of course children sense the general atmosphere of the home and parents’ arguments often make them feel insecure. A hung-over mom may also make the children worry when they see that she is unwell but do not know why.

You told that you go out to party 2 – 6 times a month, i.e. once a week on average. This does not sound very occasional. You do not tell more about your history with intoxicants or how much you drink, but judging from your memory losses you do drink enough to become intoxicated. Weekly intoxication exceeds the limits of safe alcohol use, so you really should try to cut down. The memory loss sounds particularly worrying.

Safe alcohol use can be compared to limits of large-scale consumption, which for women are 16 units of alcohol per week or 5 units of alcohol per a drinking session. If you exceed these limits regularly, the probability of alcohol-related harms increases considerably. A good way to monitor your drinking is a so-called drinking diary, where you write down the units of alcohol consumed each day. One unit of alcohol equals e.g. a bottle (0,33 litres) of medium strong beer, a glass (12 cl) of mild wine or a shot (4 cl) of spirits.

You’re also wondering whether you could be an alcoholic. There are clear diagnostic criteria for alcohol addiction or alcoholism. These include, among other things, a strong craving or a compulsive need to drink, weakened ability to control when to start drinking, how much to drink or how to stop drinking, withdrawal symptoms when you stop drinking (either hangover or alleviating the symptoms with a few drinks), increasing tolerance for alcohol, drinking becoming a central issue in your life and continued use of alcohol despite the harms it is causing. Three of these criteria have to be present continuously for a month or repeatedly, if the drinking periods last less than a month. Alcoholism is, in other words, not an issue of how much you drink, but rather what your relationship to alcohol is.

Different self-assessment tests have been developed to help you assess whether your alcohol use is harmful. One of the most well known and simple is the CAGE questionnaire that consists of four questions:

1. Have you ever felt the need to cut down on your drinking?
2. Have you ever felt annoyed by people complaining about your drinking?
3. Have you ever felt guilty about your drinking?
4. Do you ever drink an eye-opener in the morning to relieve the shakes?

In Finland the limit suggesting large-scale consumption is for women 2 points or more, and each affirmative answer equals 1 point. A questionnaire consisting of only four questions is of course somewhat crude, but it does give some indication on the state of the matters. You can also try the self-assessment test here at AddictionLink to get a clearer picture of your situation.

I sensed from your question that you have been struggling with these issues alone. You said that your husband does not really understand your problem. This is quite natural: it is difficult for people to have an objective attitude towards the drinking habits of loved ones and see the others’ anxiety behind their own fear and anger. You should talk about the feelings that your drinking arouses in your husband. It would be an even better idea to seek the help of a neutral professional. The most logical option is probably to go to the nearest A-Clinic. You can find the contact information of an A-Clinic near you on the A-Clinic Ltd’s web site (https://www.a-klinikka.fi/en) or your local phone book. A-Clinics specialise in the treatment of intoxicant and addiction problems, and you can think over your situation and the solutions together with a professional. The services of A-Clinics are confidential and free of charge.

At A-Clinics intoxicant-related problems are considered a problem that touches the whole family, and therefore the whole family is also included in the treatment. A-Clinics also offer couples and family therapy. If your children have begun to exhibit symptoms because of the situation, the local family guidance centre is the best place to help them. A-Clinics and the family guidance centre can also co-operate if needed with your permission.

By contacting this service you have shown that you want to carry the responsibility for your own behaviour and for your family. As you said, you have “a good husband and two wonderful children” who could be your source of strength in this struggle. You said that you don’t think you are an alcoholic, at least not yet, and I agree on both accounts. Your alcohol use seems to be connected to the emptiness of your life. However, you can’t go on like this because more serious problems will soon begin to appear. At this stage it is still relatively easy to influence things. I encourage you to take the next step and contact your local A-Clinic (or any social or health care professional, who can refer you to the appropriate place) and tell them honestly about your situation. You and your family do not need to deal with these problems alone, because help is available.

My husband is in the middle of one of his drinking bouts (again). He has been drinking now for two weeks. He drinks about two bottles of spirits a day. When he’s drunk, he’s often violent. Nothing very serious has happened yet though I am not sure if I have the courage to call the police. He has had these drinking bouts for several years now and everything seems to be getting worse.

My husband is a lonely man. Recently he resigned from his job when they tried to talk him into seeking help. I don’t have the energy to keep in contact with my friends. I would be too embarrassed to invite anyone over. We have a son and a daughter who both go to school. They too seem confused and worried about dad’s drinking. The situation probably affects them as well. Our son has had some problems at school, he has fits of rage and he has been teased. Our daughter is more of the meek and mild type.

I don’t know what to do. I feel I have very little strength left. I’ve tried talking and yelling at my husband, but to no avail. He just blames me and says it’s my fault he’s drinking. What is my responsibility regarding my husband’s drinking? I feel like I would be abandoning him if I left now. Is there something I can do to help my husband get sober? How could I help my children who live in a situation that is too much for them? I don’t want to contact child welfare or social authorities because I fear they would take our children away from us. I also do not want to go to the local A-Clinic, and my husband would certainly never go, as we live in a small town.

The Answer
You bring up a very important issue. Expressing your own worries is the first step towards influencing your husband’s drinking and violent behaviour. A person with an alcohol problem cannot see his own state and often denies he has a problem. Often he blames his loved ones for his behaviour and makes them feel guilty. People close to him may therefore think that they are partly responsible. However, a violent act towards another person is always wrong. You don’t have to accept your husband’s violent behaviour.

The person who is violent and/or suffers from alcohol problems must seek help himself. He must initiate the change himself, as no one else can change him. You can’t really help anyone but yourself and your children. In this situation it is particularly important that you and your children receive help and support. It is important that you have the energy to go on. The best way to help your husband is to respect his responsibility for his own choices and to take responsibility for your life and the lives of your children. It also often happens that when the wife seeks help and support her behaviour and roles at home change. This, in turn, gradually affects the husband’s behaviour.

You said that you do not want to contact your local A-Clinic and that you are afraid to contact the child welfare and social authorities. It is not always easy to seek support and begin to influence things and you may think about things for a long time before you take the first step. However, it is often difficult to change the interactional patterns within the family without the views and support of an outsider.

If you are worried about your children’s welfare in the present circumstances, you can contact the person in charge of child welfare at your local social service centre. The main focus of child welfare services in Finland is the child’s interest and the aim of the services is to support families. Child welfare services are confidential and are always carried out in co-operation with the family. The aim is to allow the children to grow up in their own home. Most child welfare services are non-institutional which means that a social worker works with each family individually, in co-operation with the parents and the children. Solutions are always family-specific and individual.

Depending on the family situation child welfare services may co-operate e.g. with health care workers. It is a good idea to discuss things relating to school also with the teacher or school curator. Sometimes it might be wise to contact the local family guidance centre. Contact the services of your wellbeing services county.

The national Kalliola Clinics arrange courses for people who have lived with intoxicant abusers. The courses provide you with the knowledge that you are not alone with your problem. At the same time you can learn how others cope with these problems and possibly learn new ways of coping that you find useful.

Self-help groups for friends and family members of alcoholics, Al-Anon groups, are surely arranged also in your municipality. They are a forum for discussing matters and situations that are familiar to people who live with alcoholics. By sharing their experiences the members of the group find new ways of coping. There are also similar self-help groups for 10 – 20-year-old children. They are called Alateen groups. You can find out more about these groups on their web site: https://www.al-anon.fi/

If the situation (either yours or your children’s) at home begins to get threatening or dangerous because of your husband’s violent behaviour, I suggest that you immediately contact your local social service centre who can tell you about the shelter nearest to you. Shelters are meant for family members who suffer from domestic mental or physical abuse. They are on call 24 hours a day. You can find out more about shelters at The Federation of Mother and Child Homes and Shelters (contact points in English can be received by calling their office directly).

It is now very important for you to take care of yourself and your children. It is important for your children’s welfare that you have the energy to go on. I hope that you will start working on your own welfare. Do not hesitate to give the services I’ve mentioned a try. It is important that you find a form of support that suits you and your children best.

There are still conflicting views on the health hazards of cannabis use as they have not been sufficiently studied. However, it is somewhat certain that the use of cannabis can cause immediate health hazards to a person experimenting with it or using it occasionally. It is good to be aware of the risks of long-term use if you are thinking about experimenting with cannabis or beginning to use it.

Cannabis is the most commonly used intoxicant. The intoxicating effect of cannabis varies with the strength of the substance, amount, way of using it, the environment it is used in and the characteristics of the user. Cannabis is not poisonous. There are no recorded cases of poisoning deaths from the use of cannabis alone.

Cannabis high causes behavioural or psychological changes such as weakened kinetic functions, pleasure, sometimes anxiety, impaired judgement or social withdrawal. The ability to concentrate, remember and handle activities requiring precision becomes weaker. Cannabis strengthens the effect of other intoxicants and makes the user less attentive and slower to react. The risk of accidents may increase if the driver of a vehicle has taken cannabis. Also, symptoms of serious mental illnesses may appear more easily for users who are genetically predisposed to them.

The effects become apparent during the use of cannabis or shortly after. Typical physical changes include bloodshot conjunctiva (the white of the eyes), increased appetite, dryness of the mouth and elevated heart rate. When smoked, cannabis starts to have an effect within a few minutes. The intoxicating effect lasts for a few hours.

Regular long-term use of cannabis will probably cause irritation of the airways, infections and malignant changes such as lung cancer. Some regular, long-term users of cannabis become addicted to cannabis so that they no longer can be without it or control its use. Long-term use also involves deterioration of memory and skills of observation After a long period of sobriety the powers of observation and memory may improve.

Some evidence also suggests that the use of cannabis increases the cancer risk in the areas of mouth, throat and gullet. If a mother uses cannabis during pregnancy her child may get leukaemia. Use of cannabis may worsen adolescents’ performance at school and adults’ ability to perform work assignments that require high intellectual capabilities.

Even though individual differences are great, it is likely that adverse effects are more common in certain groups than is expected. Adolescents who do badly at school and have started to use cannabis at a young age are more likely to start using other drugs and to become addicted to cannabis. If the mother uses cannabis while she is pregnant it may increase the risk of premature labour. The use of cannabis can also aggravate the symptoms of certain diseases, such as asthma, bronchitis, schizophrenia, alcoholism or other substance addictions.

Amphetamine psychosis is a psychotic mental health disorder that is caused by the use of amphetamines and is therefore traditionally classified as a so-called organic psychosis. The term psychosis usually refers to a mental disorder where the patient’s sense of reality is distorted due to delusions or hallucinations (auditory, visual or olfactory) and possibly due to fluctuations in consciousness. Amphetamines may cause psychotic symptoms in various ways, but usually the term ‘amphetamine psychosis’ is refers to a delusional state, brought on by the use of amphetamines that do not involve clear hallucinations or changes in one’s state of consciousness. It is caused by high-scale, long-term use of amphetamines. Risks are increased by aging, mixed use of substances and physical illnesses. It may also become chronic and more serious if the use of amphetamines continues.

Typical symptoms of amphetamine psychosis include paranoid delusions where the patient feels he/she is threatened or under persecution, even though in reality exists no grounds for these feelings. The patient keeps glancing nervously around and is excessively sensitive to perceptions of others. Quite possibly one doesn’t suffer from hallucinations. Amphetamine psychosis may be difficult to distinguish from psychosis typical of schizophrenia, but under professional supervision patients recover quicker and with greater ease as long as they stop using amphetamines.

Patients who suffer from schizophrenia and use amphetamines have psychotic states that are characterised by problems unique to them. In these cases it may be difficult to estimate which symptom is caused by which factor. Amphetamine psychosis, like other psychoses, is usually treated with antipsychotic medication and other psychiatric care. Treatment can take place at a psychiatric hospital although milder psychoses can also be treated in outpatient care.

Ecstasy decreases the amount of serotonin receptors in the brain. Serotonin is an important transmitter in the processing of information, including remembering and learning. In other words, ecstasy affects your memory. It is still uncertain how much ecstasy is needed to cause cognitive deficiency symptoms. The latest studies have shown that the memory and learning difficulties observed are connected solely to ecstasy use and not to other drugs taken in connection with it.

Structural changes in the brain caused by ecstasy have been found even years after the patient has stopped using ecstasy. Structural changes diagnosed for example by brain imaging have mostly been broken connections between the neural pathways both on the cerebral cortex and the base of the brain. This includes the area of the memory centre. Cognitive functions that have been found to deteriorate due to ecstasy use include reaction time and speed, remembering and the ability to learn.

Users of ecstasy remember less, learn more slowly and forget more than those who do not use drugs. This effect can be seen already when the use has continued on a fortnightly basis for 1-2 years.

Some studies indicate that difficulties relating to memory affect only large-scale consumers of ecstasy, not those who use moderate doses on weekends. Other studies, however, indicate that the use of ecstasy causes cognitive changes even if the doses are relatively small. More than ten times of use is said to be the critical amount as far as memory difficulties are concerned.

The ability of ecstasy users to memorise lists of words compared to that of healthy non-drug users discovered that users of ecstasy remembered 60 – 70% less words when compared. In comparison to cannabis users, the users of ecstasy required more repetition in order to be able to memorise the list and they also forgot learnt words quicker. Ecstasy users also score lower marks in visual attentiveness. This is shown by longer reaction times in visual multiple-choice questions. In addition, the amount of mistakes ecstasy users make is considerably larger when compared to users of cannabis. According to studies, the problems ecstasy users have in cognitive performances are not connected to the acute effect of the drug nor to the muddled feelings experienced after its high.

All in all, not even occasional use of ecstasy can be considered harmless as far as memory and other cognitive functions are concerned. Studies have found that the use of ecstasy, even in small doses, continued for months and years, may cause long-term problems in cognitive performance. Memory problems have been diagnosed even up to six months after the patient has stopped using the drug. The memory of some users improves after a few months, but their performance in memory tasks remains lower than that of non-drug users.

Apart from remembering and learning, other cognitive functions seem to remain intact. This may be due to the plasticity of the brain of adolescents. On the other hand it is possible that harmful effects appear later, as the users get older, because the re-uptake of serotonin in the brain decreases with normal ageing. Therefore ageing may cause a faster decrease of cognitive abilities in ecstasy users. This can be seen only as current users get older and when the follow-up studies on them are finished.

LSD is a hallucinogenic drug which means that it causes distortions of perception, such as hallucinations. If actual hallucinations occur, the user’s state can, depending on the definition, be considered a psychotic state where his sense of reality is distorted, even if the user himself is aware of what causes the hallucinations.

Sometimes LSD causes an acute state of disorientation, in connection with hallucinations, that may affect the user’s moods for days. As a general rule LSD, unlike PCP, does not cause full-blown psychoses if it is used only in small amounts for a short period of time. If the user already suffers from a psychotic disease then this is not the case and should therefore be noted that many hallucinogenic substances may, in addition to their intoxicating effect, also trigger psychotic symptoms in users who are predisposed to psychosis, making existing symptoms potentially worse. Persons who are predisposed to anxiety or other, more serious mental disorders may easily suffer from panic disorders or states similar to a mild psychosis when they use LSD.

In connection with LSD, so-called bad trips and flashback experiences are often mentioned. “Bad trips” refers to severe anxiety and fear that is connected to the intoxicated state induced by LSD. Flashback experiences refer to a recurrence of the effects of LSD even long after its original use.

Long-term use of LSD predisposes the user to psychotic personality changes and even to schizophrenic, psychotic symptoms. However, distinguishing between psychotic symptoms related to LSD use and other, pre-existing mental disorders is very difficult.

The panic-like states and short-term psychotic symptoms related to LSD use can usually be treated simply by calming things down. Only occasionally is mild, tranquillising medication needed to ease the situation. Problems caused by chronic use of LSD may instead require thorough, long-term treatment.

In drug user circles there are different views on how the effects of drugs could be enhanced. According to one of these views, boosters i.e. antidepressant medicines (especially the MAO (monoamine oxidase) enzyme inhibitor Aurorix) would strengthen the effect of ecstasy. However, the combination of the two has proven fatal, as it easily induces a state of poisoning known as serotonin syndrome which can lead to death.

In Finland, the deaths related to the use of ecstasy have been caused precisely by the combined use of ecstasy and antidepressants. The use of boosters in connection with ecstasy and other amphetamine derivatives is, in other words, a lethal combination and one you should not try.

The effects of ecstasy are caused by the body’s neural transmitters. Ecstasy releases monoamines from the nerve endings of the brain and inhibits their reuptake. A large amount of transmitters, especially serotonin, that is released into one’s system causes the desired effects in the user’s central nervous system, while at the same time depleting the monoamine stores of the body.

What happens when the amphetamine derivative ecstasy is combined with the antidepressant Aurorix?

The synaptic cleft is a place between two neurons where nerve impulses are transferred from one nerve cell to another via the transmitter. Ecstasy adds dopamine and serotonin into the cleft from the nerve endings of the brain while and at the same time blocking the exit pathway of the synaptic cleft. Simultaneously, the MAO inhibitor Aurorix prevents the functions of the enzymes that destroy both serotonin and amphetamines, eliminating the last possibility the body has to fight the serotonin flood.

In other words, when the two substances are used simultaneously a risk of death is present. As the amount of amphetamine increases in one’s system (“taps into the synaptic cleft opened”), the Aurorix prevents the functions of the MAO enzyme (set to destroy serotonin and amphetamines) and blocks the exit pathway of the synaptic cleft (“exit plugged”). Extreme caution should be taken with boosters.

The risks of ecstasy:

Ecstasy should not be used often because one’s transmitter stores require time to replenish. A constant depletion could lead to depression. The view that antidepressants that raise serotinin levels would protect the serotonin nerves against the destructive elements of ecstasy has not been supported in studies. Ecstasy is a neurotoxin. As little as 20 times its use has been shown to decrease the user’s ability to remember, learn, think logically and deduce. Other possible side effects or risks from occasional use are panic, nausea or a state of confusion. Using ecstasy more frequently and in larger amounts increases the risk of long-term, possibly irreversible changes to the brain.

Hepatitis C can occur completely without symptoms. If symptoms do appear, they are similar to other viral hepatitis. First symptoms may include fever, loss of appetite, nausea and jaundice of skin and whites of the eyes. If symptoms do appear, they usually appear no sooner than three weeks and no later than three months after the infection.

I heard that I have to take a drug test during a health inspection when I start working at a new workplace. Now I’m very worried. How long will different drugs stay in my system and be evident in the urine test? What if the test shows that I’m on prescription medication? Who will get to know the test results? If the test shows that I’ve used drugs, will the police be informed? I thank you in advance for the answers!

The Answer
how different substances show up in different tests depends on many factors and it is therefore not possible to give an exhaustive answer to your first question. The factors that influence test results include e.g. the method of analysis, the substance used, the purity of the substance, the amount used, the frequency of use, how much time has passed since the substance was last used, how long you have been using the substance, how the substance is used, as well as many individual factors (e.g. body build). Different methods of testing also produce different results. The most commonly used so-called instant tests only tell whether a substance is present in the system. More accurate analysing equipment also tell how much of the substance is present within the system. The most reliable results are obtained from urine samples, but blood and hair samples can also be used.

How long various substances can be detected within one’s system varies considerably. In principle the longest enduring substances include cannabis and certain medicines (mainly benzodiazepines), whereas opiates and opiate derivatives disappear from the system relatively quickly. A rule of thumb is that cannabis can be detected 1-5 days after it has been used in an occasional user and even up to 14 days after the use in a more habitual user. Amphetamine can be detected 2-6 days after use Heroin and morphine 1-2 days after the use. Buprenorphine remains in the system only for 0-1 days and cocaine 1-2 days. The detection time for benzodiazepines varies considerably depending on the medicinal substance. For example, midazolam can be detected for 1-2 days and oxazepame 5-7 days, whereas diazepam can be detectable up to 21 days.

Tests also do not tell whether the person has used the substance with the intention of becoming intoxicated. If you use prescription medication according to your doctor’s recommendations, you are not misusing medicines. When you take the test, bring along the prescriptions your doctor has given you so, if needed, you can prove that the medicine in question has been prescribed to you in treatment purposes.

Issues relating to drug testing are confidential, and the personnel administering the tests are bound by the same confidentiality as other social and health care professionals. The practices of health inspection vary but in principle the statement should not detail the worker’s state of health or his test results, but only to state whether or not the person is suited to his job.

Matters relating to drug testing in working life are still relatively new in Finland, and even the legislation on the matter is only now being prepared. Social and health care professionals have an obligation to inform the police only in case of serious crimes, ones that carry a penalty of more than six years of imprisonment. Use of drugs is not one of those crimes.

In your question you did not specify what substances you have used or why this matter particularly worries you, so unfortunately I cannot be more specific. Of course, no one can be forced to take the drug test, but on the other hand the employee has no obligation to hire anyone. You can naturally inquire about anything relating to the test and the use of the test results from the testing personnel before the test.

I just found out that I’m pregnant. Now I fear that I may have caused some damage to my baby. Before I found out that I was pregnant, I had a few drinking binges when I got really drunk. Earlier, perhaps a year ago, I have also smoked marijuana a few times. Can it still cause harm to my future baby? I’ve heard that cannabis remains in the system for a very long time.

The Answer
Thank you for your question. It sounds good that you have such a responsible attitude towards pregnancy and having a baby. Pregnancy and becoming a mother brings a lot of new responsibilities for a woman. Motherhood is a developmental process that begins as soon as you find out that you are pregnant. At its best it includes joy and happiness as well as worries and sorrows. That you are concerned about what consequences your own behaviour has for the child is a good and life-sustaining quality. It is good that you think about the effects of alcohol use already at this stage.

I’m glad I can ease your mind somewhat: occasional alcohol use before the mother knows she’s pregnant will probably not cause problems. Even in normal pregnancies – without any particular predisposing factors – there is a 2-3% chance that the foetus will develop some abnormalities. Occasional alcohol use before the mother even knows she is pregnant does not noticeably increase this risk. The earlier cannabis use that took place before the pregnancy will not have any effect. You need not worry about these things anymore, so just concentrate on the pregnancy. Contact the maternity clinic where you will also get information about nutrition during pregnancy.

However, it is important to be aware of the risks that the foetus may be exposed to if the mother continues to use alcohol or drugs. The foetus begins to differentiate and develop as soon as the mother misses her period, so the mother should stop drinking as soon as she suspects that she may be pregnant.

As no safe limit for alcohol use during pregnancy is known, you should avoid alcohol throughout the entire pregnancy. Generally speaking, it is a good idea to avoid drinking already when pregnancy is being planned, as the mother often does not know she’s pregnant during the first few weeks. Even moderate use of alcohol can also affect your fertility and make it more difficult for you to get pregnant.

Alcohol easily penetrates the placenta and is carried into the foetus. The foetus cannot process alcohol as quickly as an adult, so the alcohol content in the foetus may be even higher than that in the mother. Large-scale, repeated alcohol use in the early stages of pregnancy increases the risks of deformations and miscarriage. Repeated drinking or heavy, occasional drinking during the pregnancy may cause foetal alcohol syndrome (FAS), which causes the baby to have abnormal physical features, short body-length, a small head and possibly developmental disorders of the central nervous system. Depending on the severity of the disorder, the problems may manifest themselves in childhood as learning disabilities, behavioural problems or mental retardation.

Earlier marijuana use has no effect on a pregnancy that begins later. Using marijuana or smoking cannabis during pregnancy, however, will decrease the blood flow in the placenta and may interfere with the foetus’s nutrient supply and thereby slow down growth. Long-term effects (effects that become evident later in life in e.g. behaviour) are possible, if the mother uses these substances during pregnancy.

Becoming a mother makes us think about our attitudes towards many things, including intoxicants. A new, developing life makes us responsible in an entirely new way. I wish you a wonderful and harmonious pregnancy.

I’m a 45-year-old man, married with children. I have a stressing and demanding job that also requires me to travel a lot. At first I had a few beers in order to relax after work, but now the drinking is out of hand. Often both Friday and Saturday are spent drinking. In the evenings in hotels I don’t really have anything else to do and it is so easy to have a few beers or a bottle of red wine at a restaurant. In addition, I’ve started to take anti-anxiety medicines (Oxepam and Diapam) that has earlier been prescribed to me for tension and depression. Before I go to bed I have to take a sleeping pill (Imovane) in order to be able to sleep. My wife is very worried and angry. She threatens to leave and take the children with her if I don’t stop drinking. I do not want to lose my family. I can take care of my job. Do you have any suggestions as to how I could control my drinking?

The Answer
You have taken the brave first step by contacting this service! You have reason to worry about your drinking. I’m worried about the fact that you have had to use medicines for anxiety and sleeping disorders. The medicines you mentioned are benzodiazepines that can have unpredictable and even life-threatening effects when used together with alcohol. It is absolutely forbidden to take them when you have been drinking. You can also become physically addicted to benzodiazepines. Psychological addiction is based on the belief that you cannot live with the symptom without the medication. Gradually, however, the medicines begin to cause the very same symptoms they were meant to cure, so these medicines are to be used only temporarily.

I got the impression that you have got stuck in a vicious circle. Anxiety and sleeping disorders are often the result of drinking, so in a way your drinking causes your need for these tranquillisers and sleeping pills. I recommend that you abstain from alcohol entirely for a month. During this time all withdrawal symptoms will disappear and based on the symptoms that possibly remain your need for medication can be reassessed.

There are plenty of suggestions that you asked for but there is no patented miracle cure. First you must find out what it is that you want to change and what your hopes are. You said that you do not want to lose your family. It would be a good idea to discuss matters with your wife: how she feels about your drinking and how she would like things to change in order to be able to continue sharing her life with you. And what about you: are you ready to give up drinking completely or is your goal a so-called moderate use of alcohol? Why do you need alcohol? Could you e.g. relax and release work-related tension in some other way or change the situation at work so that the pressure would not be unbearable? What harms has your alcohol use caused you and your loved ones? What does alcohol give you; what would be missing from your life if you did not drink? In which situations are you able to you control your alcohol use and when does it get out of hand?

If you aim at moderate use, it is important to keep track of the amount of alcohol consumed e.g. by writing down daily all alcohol units you have had. When you aim to use alcohol moderately, set clear, measurable goals or a limit you must not exceed. A good standard of comparison is the limit for large-scale use, which for men is 24 units per week and 7 units per day. If you exceed these limits regularly, the likelihood of alcohol-related harms increases considerably. If your drinking diary shows that you can’t keep within the set limits, you should rethink and redefine your goal.

Planning ahead is essential when you work towards moderation or sobriety. If you know you will be facing a situation where alcohol will be offered, plan ahead how you can say no or, if you intend to drink, how much and how quickly you will drink. Otherwise it is easy to slip. Also, think about what you could do instead of drinking in situations where you usually drink.

Nowadays there are also medicines for controlling drinking and cravings. For those who want to become completely sober there is Antabus which causes unpleasant reactions with alcohol (palpitations, blushing of the face, nausea etc.). You should absolutely not drink when taking Antabus as the joint effects may be even life-threatening.

Naltrexone is suitable for controlling drinking. It is sold at pharmacies under the brand name ReVia, and it decreases the feelings of pleasure and incipient intoxication when you drink alcohol. ReVia does not have any unpleasant effects when used together with alcohol, but the use of opiates and thioridazine-based medication is forbidden. ReVia is usually a well-tolerated medicine. The most common side effects include nausea and tiredness but they will usually abate within a week. Best treatment results have been achieved by combining the medication with cognitive therapy.

You have already taken a big step by writing to AddictionLink so you shouldn’t leave it at this. From what you’ve told it seems that you still have a lot of valuable resources (work, family and most importantly, the willingness to change), so I believe you can get through this situation. Do not hesitate to contact e.g. your local wellbeing services county or A-Clinic and take concrete actions. The earlier you tackle drinking problems, the easier they are to be solved!

More information on mixed use of alcohol and pharmaceuticals: Combined use of alcohol and medicines

On benzodiazepines: Benzodiazepines

On alcohol addiction and its treatment: Services for adults

On sleeping pills and tranquillisers: Misuse of pharmaceuticals