[11] Alcohol Abuse Flashcards
What is alcohol abuse?
Alcohol abuse is the consumption of alcohol at a level sufficient to cause physical, psyciatric, and/or social harm
What is binge drinking?
Binge drinking is drinking over twice the recommended level of alcohol per day in one session (>8 units for men, >6 units for women)
What is harmful alcohol use defined as?
Drinking above safe levels, with evidence of alcohol related problems
What mediates the pleasurable and stimulant effects of alcohol?
The effect of alcohol on the dopaminergic pathway of the brain
What effect does repeated, excess alcohol ingestion have on the dopaminergic pathway of the brain?
It sensitises the pathway, and leads to the development of dependence
What effect does long-term exposure to alcohol have on the neurotransmitters in the brain?
It causes adaptive changes in several neurotransmitter systems, including down-regulation of inhibitory neuronal GABA receptors, and up-regulation of excitatory glutamate receptors, so when alcohol is withdrawn, it results in central nervous system hyper-excitability
What neurological systems has craving in alcohol use disorders been linked to?
- Dopaminergic, serotonergic, and opioid systems that mediate positive reinforcement
- GABA, glutamatergic, and noradrenergic systems that mediate withdrawal
What does the social learning theory say about drinking behaviour?
That drinking behaviour is modelling on imitation of relatives or friends
What does operant conditioning say about drinking behaviour?
That positive or negative reinforcement from the effects of drinking will either perpetuate or deter drinking habits respectively
What are the risk factors for alcohol abuse?
- Male gender
- Younger adults
Genetics - Antisocial behaviour
- Life stressors
What are the symptoms of alcohol intoxication?
- Slurred speech
- Labile affect
- Impaired judgement
- Poor co-ordination
- Hypoglycaemia
- Stupor
- Coma
What are the ICD-10 criteria for alcohol intoxication?
General criteria for acute intoxication met, with clear evidence for psychoactive substance use at high dose levels, and disturbance in consciousness, cognition, perception, or behaviour that is not accounted for by a medical or mental disorder.
There should also be evidence of dysfunctional behaviour such as disinhibition, argumentativeness, aggression, labile mood, impaired attention/concentration, and interference with personal functioning.
They should have at least 1 of;
- Unsteady gait
- Difficulty standing
- Slurred speech
- Nystagmus
- Flushing
- Decreased consciousness
- Conjunctival injection
What are the symptoms of alcohol dependence?
- Subjective awareness of compulsion to drink
- Withdrawal symptoms
- Avoidance or relief of withdrawal symptoms by further drinking
- Reinstatement of drinking after attempted abstinence
- Increased tolerance to alcohol
When do the symptoms of alcohol withdrawal occur?
6-12 hours after abstinence
What are the symptoms of alcohol withdrawal?
- Malaise
- Tremor
- Nausea
- Insomnia
- Transient hallucinations
- Autonomic hyperactivity
What is the severe end of the alcohol withdrawal spectrum termed?
Delirium tremens
What is delirium tremens?
Withdrawal delirium that develops between 24 hours and one week after alcohol cessation
When is the peak incidence of delirium tremens?
72 hours
What is the predisposing factor to delirium tremens?
Physical illness
What symptoms is delirium tremens characterised by?
- Cognitive impairment
- Vivid perceptual abnormalities
- Paranoid delusions
- Marked tremor
- Autonomic arousal, e.g. tachycardia, fever, pupillaey dilation, increased sweating
- Dehydration
How is delirium tremens managed?
- Large doses of benzodiazepines
- Haloperidol for any psychotic features
- Intravenous Pabrinex
What are the ICD-10 criteria for withdrawal?
The general criteria for a withdrawal state should be met, with clear evidence of recent cessation or reduction or substance after prolonged or high level usage, and symptoms should not be accounted for by a medical or mental disorder.
They should show at least 3 of the following;
- Nausea/vomiting
- Tachycardia/increased BP
- Headache
- Psychomotor agitation
- Insomnia
- Malaise
- Transient hallucinations
- Grand mal convulsions
What are the hepatic long-term effects of alcohol consumption?
- Fatty liver
- Hepatitis
- Cirrhosis
- Hepatocellular carcinoma
What are the gastrointestinal long-term effects of alcohol consumption?
- Peptic ulcer disease
- Oesophageal varices
- Pancreatitis
- Oesophageal carcinoma
