8: Alcohol use disorders

Question 1

Which percentage of the population drink half of all alcohol consumed in the UK?

Answer 1

10%

Question 2

Which groups of the population have the highest rates of drinking?

Answer 2

Adolescents

20 - 30

Question 3

What is a unit of alcohol?

Answer 3

10ml of pure alcohol

Question 4

What is a high risk drinker?

Answer 4

Someone who consumes > 14 units of alcohol per week

Question 5

What are the UK guidelines for alcohol consumption?

Answer 5

< 14 units per week

Ideally spread throughout the week

With at least three drink-free days

Question 6

The harm caused by excessive alcohol consumption may be ___, ___ or ___.

Answer 6

physical

mental

social

Question 7

As alcohol is an ___ drug, you can become ___ on it.

Answer 7

addictive

dependent

Question 8

According to the ICD-10, what are some signs of dependence on an addictive drug?

Answer 8

Strong desire to take drug

Difficulty stopping once you’ve started

Persistent use despite evidence of harm (physical, psychological, social)

Neglect of other interests

Development of tolerance

Physiological withdrawal state if abstinent

Question 9

Which tools can be used to detect harmful drinking in a patient?

Answer 9

AUDIT questionnaire

CAGE questionnaire - cut down, annoyed, guilty, eye-opener

Question 10

Which tool is most commonly used in Scotland to detect harmful drinking?

Answer 10

AUDIT

Question 11

In alcoholic liver disease, which liver enzymes may be raised?

Answer 11

ALT

AST

GGT

(AST > ALT because you’re wASTed)

Question 12

How can you raise the issue of harmful alcohol consumption in a consultation?

Answer 12

Brief intervention

same as with smoking

Question 13

Which tool is used to measure a patient’s alcohol dependence?

Answer 13

SADQ

severity of alcohol dependence questionnaire

Question 14

The greater your AUDIT and SADQ scores, the greater the ___ you need.

Answer 14

intervention

Question 15

What are specialist interventions for alcohol dependence?

Answer 15

Detoxification

Relapse prevention

Question 16

Alcohol is a (stimulant / depressant).

Answer 16

depressant

Question 17

Which receptor does alcohol inhibit?

Answer 17

NMDA-glutamate (excitatory receptor, remember alcohol is a depressant)

Question 18

Which receptor does alcohol stimulate?

Answer 18

GABA (inhibitory receptor)

Question 19

Which receptors are

a) downregulated
b) upregulated

in chronic alcoholism?

Answer 19

a) Inhibitory receptors are downregulated due to overstimulation

b) Excitatory receptors are upregulated due to inhibition, leading to anxiety, dysphoria and seizures

Question 20

What happens to dependent patients who don’t consume alcohol?

Answer 20

Withdrawal

Question 21

What are some physical symptoms of acute alcohol withdrawal?

Answer 21

Tremor

Sweating

Nausea

Visual hallucinations

Seizures

Question 22

What occurs within 3 - 5 days of alcohol withdrawal syndrome?

Answer 22

Delirium tremens

Seizures, may be fatal

Question 23

How is alcohol withdrawal syndrome managed?

Answer 23

Benzodiazepines (diazepam, chlordiazepoxide)

Vitamin supplementation (e.g thiamine; vit b1 to prevent encephalopathy)

Question 24

Which vitamin deficiency can present in alcoholism?

Answer 24

Vitamin B1

Question 25

Which neuro problems are caused by

a) acute
b) chronic

thiamine deficiency?

Answer 25

a) Wernicke’s encephalopathy (reversible)
b) Korsakoff syndrome (irreversible)

Question 26

What is the name of the Vitamin B1 supplement given to alcohol withdrawal patients?

Answer 26

Pabrinex

Question 27

What is disulfiram?

Answer 27

Acetaldehyde dehydrogenase inhibitor

Makes patients feel crap when they drink alcohol (flushing, nausea)

Question 28

What drugs, given for alcohol misuse disorders, reduce

a) alcohol cravings
b) alcohol’s rewarding effects?

Answer 28

a) Naltrexone - craviNgs
b) Acamprosate - rewArd