3.9 Alcohol use disorders

Question 1

What should you say to a patient with an AUDIT score of 0-7?

Answer 1

This is lower risk drinking

Reinforce current drinking patterns.

Question 2

What should you say to a patient with an AUDIT score of 8-14?

Answer 2

This is hazardous drinking.

Deliver brief intervention.

Question 3

What should you say to a patient with an AUDIT score of 15-19?

Answer 3

This is harmful drinking.
Deliver brief intervention.
Deliver motivational enhancement therapy sessions.
Consider prescribing options.

Question 4

What should you say to a patient with an AUDIT score of 20+ or DUI 15+ possible dependence?

Answer 4

Do a comprehensive assessment.

Question 5

What does FRAMES stand for, in brief interventions for alcohol drinking that is hazardous or harmful?

Answer 5

F-feedback
R-responsibility
A-advice 
M-menu of options 
E-empathy
S-self-efficacy

Question 6

What are the safe drinking limits for men?

Answer 6

3-4 units per day, and
Max 21 units per week

2 alcohol free days per week.
A binge is >8 units

Question 7

What are the safe drinking limits for women?

Answer 7

2-3 units per day, and
Max 14 units per week

2 alcohol free days per week
A binge is >6 units (eg. 2 large glasses of 12% wine)

Question 8

How many units of alcohol are there in a 12% bottle of wine?

Answer 8

9 units

Question 9

What questionnaire can you administer to assess and enhance motivation?

Answer 9

Readiness for Change Questionnaire RCQ

Question 10

What is included in the comprehensive assessment of alcohol intake?

Answer 10

1. Consumption- patterns, daily unit intake
2. Dependence- SAQD
3. Alcohol related problems- APQ
4. Treatment history
5. Comorbidity- physical, psychological, social
6. Other substance use histyory
7. Cognitive function assessment- MMSE
8. Readiness and belief in ability to change- RCQ?

Question 11

How should a patient with the following results be managed?

• Alcohol dependence
• AUDIT 20+
• Daily unit intake/SADQ indicate moderate dependence
• DUI 15-30
• No medical comorbidities

Answer 11

Community medically assisted alcohol withdrawal.

Question 12

How should patients with medical comorbidities and severe alcohol dependence be managed?

Answer 12

Inpatient medically assisted alcohol withdrawal

Question 13

What is Dependence Syndrome?

Answer 13

1. Tolerance- need increased amounts for effects
2. Withdrawal state- when reduced/ceased intake
3. Compulsion - strong desire to take substance
4. Impaired control of drink/drug starting/ending/amount of use
5. Preoccupation
6. Use despite clear harmful consequences

Question 14

What are the features of alcohol withdrawal syndrome?

Answer 14

1. Sympathetic: tremor, sweating, nausea, retching, tachycardia, hypertension, hyperthermia
2. Mood: anxiety, agitation
3. Insomina, nightmares
4. Perceptions: auditory, visual, tactile hallucinations x 6 days
5. Seizures- withdrawal seizures x 48H
6. Delirium tremens 48-72H, coarse tremors, confusion, delusions, hallucinations

Question 15

What drugs can be used in medically assisted alcohol withdrawal?

Answer 15

1. Chlordiazepoxide in fixing reducing doses

Question 16

Which groups may require a lower starting dose on the fixed reducing dose schedule of chlordiazepoxide in MAAW?

Answer 16

Women
Elderly
Underweight
Physical co-morbidities

Question 17

What co-morbidities would prompt an inpatient medically assisted withdrawal from alcohol treatment plan?

Answer 17

1. hx of epilepsy
2. hx of seizures or delirum tremens with previous attempts at medically assisted withdrawal
3. benzodiazepine dependence
4. Sig psychiatric or physical comorbidity
5. Sig LD or cognitive impairment
6. Homeless
7. Aged >65

Question 18

What are the characteristics of Wernicke’s Encephalopathy?

Answer 18

1. Staggering gait
2. Ophthalmoplegia
3. Confusional state
   +/- hypothermia, hypotension, nystagmus, agitation

20% mortality
Due to thiamine B1 deficiency - Treat with PABRINEX

Question 19

What are the characteristics of Korsakoff’s syndrome?

Answer 19

1. Short term memory (impairment)
2. Confabulation
3. Clear consciousness (LoC)

20% improve with thiamine - Treat with PABRINEX
25% require long term care
Due to thiamine B1 deficiency

Question 20

What is the peripheral neuropathy of alcohol like?

Answer 20

numbness
pain
hyperaesthesia
weakness

in a glove and stocking distribution
Up to 70%
Due to thiamine B1 deficiency

Question 21

What is the role of ACAMPROSATE in alcohol treatment?

Answer 21

ACAMPROSATE reduces glutaminergic activity.
Reduces alcohol cravings.
Adjunct.
Maintains abstinence.

Question 22

What is the role of NALTREXONE in alcohol treatment?

Answer 22

NALTREXONE is an opiate receptor antagonist.
Reduces pleasure of alcohol.
Reduces risk of lapse becoming a RElapse.

Question 23

What is the role of NALMEFENE in alcohol treatment?

Answer 23

NALMEFENE is an opiate receptor ANTAGONIST.

It reduces alcohol consumption.

Question 24

What is the role of DISULFIRAM in alcohol treatment?

Answer 24

DISULFIRAM inhibits acetaldehyde dehydrogenase.
It induces an unpleasant reaction after alcohol consumption.
Adjunct.
Maintains abstinence.