[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of inhibitory neuronal GABA receptors, and up-regulation of excitatory glutamate receptors, so when alcohol is withdrawn, it results in central nervous system hyper-excitability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
What are the cardiovascular long-term effects of alcohol consumption?
- Hypertension
- Cardiomyopathy
- Arrhythmias
What are the haematological long-term effects of alcohol consumption?
- Anaemia
- Thrombocytopenia
What are the neurological long-term effects of alcohol consumption?
- Seizures
- Peripheral neuropathy
Cerebellar degeneration - Wernicke’s encephalopathy
- Korsakoff’s psychosis
- Head injury (second to falls)
What are the obstetric long-term effects of alcohol consumption?
Fetal alcohol syndrome
What are the psychiatric long-term effects of alcohol-consumption?
- Morbid jealousy
- Self-harm and suicide
- Mood disorders
- Anxiety disorders
- Alcohol-related dementia
- Alcoholic halluicnosis
- Delirium tremens
What are the social long-term effects of alcohol consumption?
- Domestic violence
- Drink driving
- Employment difficulties
- Financial problems
- Homelessness
- Accidents
- Relationship problems
How is alcohol abuse investigated?
- History
- MME
- Bloods
- Alcohol questionnaires – Alcohol Use Disorders Identification Test (AUDIT), Severity of Alcohol Dependence Questionnaire (SADQ), FAST sceening tool
- CT head
- ECG
What bloods are done in alcohol abuse?
- Blood alcohol level
- FBC
- U&Es
- LFTs, including gammaGT
- Blood alcohol concentration
- MCV
- Amylase
- Hepatitis serology
- Glucose
What are the differential diagnoses of alcohol abuse?
- Psychosis
- Mood disorders
- Anxiety disorders
- Delirium
- Head injury
- Cerebral tumour
- Cerebrovascular accident
What does an alcohol detoxification regime offer?
Controlled withdrawal
Where can alcohol detoxification be carried out?
In the community, or as an inpatient
What is the intended outcome in alcohol detoxification?
Achieving abstinence
When is inpatient detoxification recommended?
- Patients at risk of suicide
- Those with poor social support
- Those with history of severe withdrawal reactions
How is alcohol detoxification carried out?
High dose benzodiazepines are given initially, and then the dose is tapered down over 5-9 days. Thiamine is also given.
What benzodiazepines are commonly used in alcohol detoxification?
Clordiazepoxide
Why is thiamine deficiency given in alcohol detoxification?
To prevent Wernicke’s encephalopathy
How is thiamine given in alcohol detoxification?
Either orally or intravenously
What pharmacological agents can be used to treat alcohol dependence?
- Disulfiram
- Acamprosate
- Naltrexone
How does disulfiram work?
By causing a build-up of acetaldehyde on consumption of alcohol, causing unpleasant symptoms such as anxiety, flushing, and headaches
How does acamprosate work?
By reducing craving by enhancing GABA transmission
How does naltrexone work?
It blocks opioid receptors in the body, thus reducing the pleasurable effects of alcohol
What are the psychological options in management of alcohol dependence?
- Motivational interviewing
- CBT
- Alcoholics Anonymous (AA)
What is the aim of motivational interviewing?
It guides the person into wanting to change
When is motivational interviewing most effective in alcohol withdrawal?
During the pre-contemplation and contemplation phases
What does CBT focus on in alcohol dependance?
Specifically on alcohol-related beliefs and behaviours
What is Alcoholics Anonymous?
A popular supportive programme for patients who accept that they have a drinking problem. It is a 12-step approach that utilises psychosocial techniques in order to change behaviour, e.g. social support networks, rewards. Each new member is assigned a ‘sponsor’ (a supervisor recovering from alcoholism)
