2 What is self harm?
3 Statistics: Alcohol and Self harm
5 Alcohol and disinhibition
6 Sex, self harm and alcohol
This project examines whether alcohol significantly increases the risk of self harm. By examining clinical research in Oxford, Northern Ireland and Scotland a relationship has been established. The statistics paint a similar picture, indicating that alcohol significantly increases self harm in men, additionally it hints at possible regional variations in relation to consumption to alcohol and self harm. Alcohols disinhibiting effects are explored to explain alcohols role in self harm. Additionally sex, alcohol and self harm is researched to explain why more men are admitted to hospital with alcohol related issues when harming themselves. Alcohol, self harm and childhood trauma is also explored in relation to women. This project challenges the assumption that self harm is a female dominated phenomenon, and raises many questions.
Societal harm has been a major concern for the masses, with the health of the alcohol consumer a secondary concern. “Until recently it has been rare for any society to focus on alcohols effects on health as a criterion of state policy.” (Room, R. 1997) This harm comes in many forms, for example “short term effects such as a hangover, an injury, or an overdose, or long term effects such as liver cirrhoses...” (Room, R. 1997) This harm, along with self harm is seen as the responsibility of the individual. “[t]here is an obvious conflict in modern societies between the doctrine of consumer sovereignty and these increasingly exacting standards of care and attention...The solution...has been to place the burden of managing of the conflict (and the blame for failure) on the individual.” (Room, R. 1997)The freedom to consume alcohol as and when we like forms a large part of Western culture, it is also a very profitable businesses for both companies and governments. If the government are willing to allow the availability of alcohol which is affordable to the masses, it would be beneficial to educate people about the risk it involves. Not just the obvious risks such as liver cirrhoses or drink driving, but its status as a risk factor for such harm.
During all my years in education I have found it curious that self harm has rarely been discussed. Perhaps it isn’t a viable subject, which doesn’t have much substance. However; “[t]he UK has one of the highest rates of self-harm in Europe, at 400 per 100,000.” (Honocks, 2002 cited in theslientcry.com. 2005) Alcohol plays a role in many reported cases of self harm. Of the 4121700 people admitted to hospital between 2003 and 2008 in England due to alcohol, 105400 (3%) was with self injury. (Statistics on Alcohol, England NHS, 2009) Much of the data is dominated by clinical research, government statistics and myths which are not often challenged. Are all self harmers mentally ill? Women? Attention seekers? The short answer is no. Self harmers are often stigmatised as mentally ill, alcoholics or illicit drug addicts and are often marginalised. However this is not always the case. It is important to understand why people self harm, is it issues from their past? Stress relief? Socio demographic variations? Regional variations? Research into self harm can help challenge the stereotypical view of self harmers and in turn enlighten the population.
In this paper I show that alcohol is a risk factor for self harmers. This is done by analysing research carried out in Northern Ireland, Scotland and Oxford. By analysing alcohols disinhibiting effects we see how alcohol can increase this risk of self harm. Although alcohol does play a role, its significance is misunderstood. The data also shows that alcohol is a significant risk factor for men. This challenges a common misconception that self harm is female dominated phenomenon.
This research differs from other in this area as it links statistics from different research and brings them together to form a convincing research project. It also looks at some the underlying factors will help to explain the conclusions of the secondary data examined in this project. It is an interesting area as it gives a deeper insight into how alcohol increases the risk of self harm. It challenges misconceptions and forms the foundations for research which will significantly improve the understanding of the relationship between alcohol and self harm. I have a personal interest in this project as I have lived with a self harmer, who would often use alcohol before, during and after self harm.
2 What is self harm?
Self harm comes in different forms and has different meanings for those who choose to practice it. Sutton (2009:6) writes “[a]lthough it can be a difficult concept to grasp, self-injury is fundamentally a coping mechanism, frequently born out of trauma or a deep-rooted sense of powerlessness.” Self harm acts as a release, a way of calming ones self down and coping with what can be described as overwhelming emotional pain. “...self-injury is seen by many as a gift of survival, rather than an act of self-destruction.” (Sutton, 2009:6) Self harm is not always an attempt at taking ones life. It is “often misconstrued as a death wish or failed suicide attempt when in all actuality, those who engage in the practice have no desire to die.” (Sutton, 2009:13)
Self harm can come in a number of forms. Direct self harm (DSI), which “is self-inflicted harm to the body serve enough to cause superficial or moderate wounds and the damage is immediate or usually visible.” (Sutton, 2009:6) This comes in a number of forms including skin cutting, slashing and carving, skin burning, scalding and erasing, self-punching, hitting, slapping, biting or bruising, self stabbing with sharp objects and bone breaking. Non-direct self harm (NDSH) on the other hand differs as “inflicting harm is rarely the aim...the damage is not immediately evident or visible...they may be oblivious to, or in denial of, the long term physical or psychological consequences of their actions.” (Sutton, J. 2009:8) NDSH can include; Extreme risk taking (i.e. reckless driving), Disordered eating, Substance misuse, Overworking, Perfectionism and Promiscuity.
Why people self harm is a complex matter. Boergers et al (1998 cited in Hawton, 2006:52) found that the main reason people self harmed was to “get relief from stress, escape from their situation and to show other people how desperate they were feeling.” Child abuse can be seen as a catalyst for self harm in later adulthood. “Numerous studies have found a positive correlation between child abuse and self injury... Eighty-four (84%) percent of the respondents who completed the survey for Healing the Hurt Within, 1st edition (Sutton 1999) reported childhood trauma/other childhood circumstances as contributory factors to their self harm.” (Sutton, 2009:140)
Statistics on the subject of self harm are problematic. For many self-harm is done in a reclusive manor. It is for many a “secretive practice carried out behind closed doors (Sutton, J. 2009:97) Many people attend to their own wounds, if this is the case countless episodes go unreported. Most of the data that is available on self harm is amassed by the medical profession due to the fact they are often needed to treat the self inflicted wounds. This is a problem as self harm becomes susceptible to medicalisation. As a result it is medical treatment and diagnosis for the act that are explored, at the expense of social reasons and individual history .
3 Statistics: Alcohol and Self harm
A correlation between alcohol consumption and self harm has long been recognised. Meltzer’s (2002) findings support this notion, this study was carried out in the UK and found that “4% of the non-alcohol dependent group had at one time, thought about suicide. This proportion increased to 9% among those moderately dependent and rose to 27% of the severely alcohol dependent groupThe rates for deliberate self-harm (without suicidal intent) were 2%, 7% and 22% for the nondependent, moderately dependent and severely alcohol dependent groups respectively.” Hawton et al’s (2006:76) findings support Meltzer’s conclusions. He also found the consumption of alcohol increase the risk of self harm. “[t]he risk of deliberate self harm rose with increasing amounts of alcohol ... adolescents who reported drinking six to ten units of alcohol in a typical week had a 3.5 fold greater risk of deliberate self harm...”
The Scottish Emergency Department Alcohol Audit, (2007), was carried out to “to determine the number and nature of attendances to emergency departments in Scotland as a result of self-harm...Sixteen out of a total of 25 mainland emergency departments took part in the study over 10 weeks from September to November 2006.” During the ten week period, “3004 were seen in emergency departments as a result of self harm...A number of patients attended more than once, bringing the total number of self-harm attendances to 3,454.” (Scottish Emergency Department Alcohol Audit, 2007) The study found that relationship problems was a dominant reason for self harm. “While ‘relationship with family’ was the most prevalent reason for self-harm among females (31%), males were less likely to state that this was a cause of their behaviour (18%). The most prevalent reason for self-harm among males was their relationship with their partner (36%) followed by alcohol (27%).” (Scottish Emergency Department Alcohol Audit, 2007) In relation to alcohol consumption The Scottish Emergency Department Alcohol Audit (2007) found that of the 3,454 admitted for self harm “62% of males and 50% of females... reported consuming alcohol...27% of men and 19% of women cited alcohol as the reason for selfharming...More than half (56%) of the people who attended an emergency department following self-harm had consumed alcohol in the previous 24 hours: 62% of males and 50% of females.” Clinical staff also reported that “32% of males and 20% of females had alcohol-related conditions in their past medical history...alcohol was a contributory factor in 40% of all self-harm presentations.” (Scottish Emergency Department Alcohol Audit, 2007),
A similar study carried out in Oxford examined the total number of deliberate self-harm (DSH) patients admitted to the John Radcliffe Hospital in 2007. Within this year the hospital examined 1557 patients who had self harmed and found “as in previous years, alcohol was often consumed at the time of DSH (30.6% of assessed episodes). This figure was higher in males (36.6%) than females (27.4%). Alcohol had very often been consumed during the six hours before the episode (49.1%), again more commonly by males (58.2%) than females (44.2%).” (Hawton, et al, 2007) Further more Hawton et al (1997) found that “[w]hen drinking histories were taken from a consecutive series of attempted suicide patients in Birmingham alcohol-related problems were identified in 34% of men and 15.5% of women.”
The Northern Ireland Registry of Deliberate Self Harm, Western Registry (2008) “extracts and collates anonymised data from existing records of self-harm attendances at the three Accident and Emergency (A&E)/Urgent Care departments in the Western area.” (Hawton, K. 2008) The reports details the results obtained during the first two years of the registries existence (2007 & 2008) “In 2007, 1,369 presentations due to self-harm were made by 1,043 individuals. There was only a slight difference in 2008 with 1,323 presentations due to self-harm made by 1,048 people.” (Hawton, K. 2008) The Northern Ireland Registry of Deliberate Self Harm (Western Area) (2008) concluded in relation to the 1,323 presentations “[a]lcohol, whilst rare as a main method of self-harm, it featured as a major contributing factor and was involved in 63.8% of all episodes of self-harm...alcohol was involved in 46% of male and 38% of female attendances.”
By analysing the data collected it is clear that there are similarities. All the data suggests that alcohol does play a role in increasing the risk of self harm in many cases. Hawton’s (2006) and Meltzers (2002) findings correlate, showing a higher level of alcohol consumption increases the risk of self harm. There could be many explanations for this correlation. For example alcohols disinhibiting effects and the relationship between self harm alcoholism and childhood trauma.
Each study found a higher correlation between alcohol consumption and self harm in men. In Scotland men were more likely to cite alcohol as the reason for self harm (27% compared to 19% in women), were more likely to have a history of drinking (32% compared to 20% in women), and were more likely to consume alcohol before self harming (62% compared to 50% in women). In Birmingham men who had attempted suicide were more likely to have a history of alcohol problems (34% compared to 15.5% in women). In Northern Ireland men accounted for the majority of cases which involved alcohol and self harm (46% compared to 38% women) Hawtons (2007) study in Oxford supports this. In Oxford men consumed alcohol during self harm more often than women (36.6% compared to 27.4% in women). This study also found that men often consumed alcohol up to six hours before self harm (58.2% compared to 44.2% in women). These statistics seem to suggest that the contribution of alcohol is more significant in men than in women.