Alc Misuse

Question 1

Dependancy

Answer 1

Primacy or salience fo drug seeking
Narrowing drug taking repetoire
Incr tol to effects
Loss of control of consumption
Withdrawal signs if abstinence
Drug taking to avoid withdrawal
Continued use depsite neg conseqs
Rapid reinstatement of prev use after abstinence

Question 2

Harm reduc

Answer 2

Safer drugs or routes of admin
Safer injec practice
Safe sex
Give maintenance opiates or BDZs
Tx comorbid mental or physical illness
Social help

Question 3

CAGE questionnairre for alc

Answer 3

Felt like should Cut back?
Ever Annoyed by critiscism of drinking?
Guilty about drinking?
Early drinking to eye open?
More than 2 pos resps suggs at risk drinking.
CAGE plus 2 adds Qs about most ever drunk in a day and a week.

Question 4

Alc mx

Answer 4

MI
Abstinence or controlled drinking
Familt counselling and how they can help

Question 5

Alc withdrawal

Answer 5

Tremor, sweat, insom, tachyc, NV, psychomotor agitat, anx.
Sometimes transient hallucins- vis, tactile, auditory.
Up to 15% have grand mal seiz.
-Delerium tremens emergency 5%- peak at 48hr after last drink. More if sev dependance, infec, and existing liver dam.
Its addit feats are- reduc conciousness, disorientat, amnesia recent, psychomotor agitiat bad, lilluputian hallucins, flucs in sev, heavy sweating, paranoid and scared, high temp, sudd CVS collapse.
Up to 10% mort.
Diffs eg hepatic enceph, head inj, pneum, psychosis, other delerium.

Question 6

Alc withdrawal mx

Answer 6

-detox-
Reducing regime may be req if symps and over 10U per day hx- BDZ for symps and reduce seiz. Chlordiazepoxide pref for outpt, diazepam for inpt.
Other meds- anticonvulsant eg BDZ, phenytoin, carbamazepine. AntiP if psychotic eg haloperidol. Vits eg thiamine, multivit, Mg etc. Other psychotropics.

Question 7

Mx

Answer 7

-counselling- soc skill, prob solving, relaxat, anger, cog restruc, relapse prevent.
-grp supp eg AA.
-residential abstinence- rehab.
-bio-
Disulfiram- aversive. irrev inhib acetaldehyde DH. S/e halitosis, headache, rarely psychosis and hepatotox.
Acamprosate- anti craving. Incr GABA transmiss. S/e eg GI, pruritis, rash, alt libido. No aversive action and no role in controlled dirnking.
Naltrexone- anti craving. Antags nat endorphins rel by alc. s/e eg GI, anx, headache, fatigue, sleep alt, flu like. Curr unlicensed.

Question 8

Misuse disorders

Answer 8

Acute intox
At risk drinking
Harmful drinking- non dpendant but contin desp harm.
Alc dependance- harmful use plus dependence synd.
pathological intox- disproportionate reac.
Alc induced amnesia.
Alcoholic hallucinosis
Alc induced psychotic disorder with delusions- persec or grandiose.
Alc rel cog impair or brain dam.
Pathological jealousy.
Wernicke enceph- acute confus, opthalmoplegia us CN6 palsy and nystagmus, ataxic gait. Tx with high potency parenteral vit B.
Korsakoff synd- impair format new mems and variab retrograde amnesia. Confabulation. Tx with oral thiamine and vits, OT, cog rehab.