Alcohol

Question 1

List the NHMRC guidelines for drinking alcohol

Answer 1

• For reduced lifetime risk of harm from drinking: No more than 2 standard drinks in any 1 day
• For reduced risk of injury in a drinking occasion: No more than 4 standard drinks per occasion
• For people <18 years: Do not drink. Delay drinking initiation for as long as possible
• Pregnant (or planning it) or breastfeeding: Do not drink

Question 2

List the systemic issues caused by alcohol

Answer 2

• Fatty liver
• Reflux disease
• Hypertension
• Pancreatitis
• Peripheral neuropathy
• Cancer

Question 3

List the mental issues caused by alcohol

Answer 3

• Confused state
• Memory impairment
• Visual impairment
• Anxiety disorder
• Mood disorder
• Psychosis

Question 4

List the social issues caused by alcohol

Answer 4

• Relationship breakdown
• Unemployment
• Social isolation
• Financial problems
• Public nuisance
• Assault
• Family dysfunction

Question 5

Describe how addiction disorders begin

Answer 5

• Rapid onset due to the pleasurable, psychoactive effects

* Causes neuroadaptation: so when the drug is withdrawn, the body feels like it is out of balance

Question 6

List risk factors for alcohol abuse

Answer 6

• Genetic
• Family history: seen people drink
• Males
• Ability to obtain and drink
• Psychological trauma
• Unemployment
• Psychiatric illness

Question 7

For withdrawal, discuss medical treatments including the drugs that are used

Answer 7

Initially, they need medical help because some withdrawal symptoms can be life threatening
• Thiamine is very important in withdrawal (managing delirium amongst other symptoms)
• Fluid balance (due to dehydration)
• Diazepam: helps prevent respiratory depression
• Haloperidol: hallucinations

Withdrawals usually finish within a week

• After withdrawal, they should go to support groups, receive counselling and receive pharmacotherapies

Question 8

Describe naltrexone as a prevention pharmacotherapy for alcohol abuse

Answer 8

• Reduces severity of relapse and blocks opioid
• Nausea is a common side effect

• Avoid in cases of liver failure or severe depression

Question 9

Describe acamprosate as a prevention pharmacotherapy for alcohol abuse

Answer 9

• Reduces cravings

• Minimal side effects
• Can be used with or without naltrexone
• Start post withdrawal

Avoid in renal failure

Question 10

Describe disulfiram as a prevention pharmacotherapy for alcohol abuse

Answer 10

• Blocks ALDH activity which is a metaboliser for alcohol

Contraindications: cirrhosis, heart disease

Question 11

Describe baclofen as a prevention pharmacotherapy for alcohol abuse

Answer 11

• Used in cases of liver diseases

* Use “off label” -> this drugs helps with relapse prevention

Question 12

Describe SSRI as a prevention pharmacotherapy for alcohol abuse

Answer 12

• Antidepressants help battle fatigue, depression, anxiety, loss of motivation, the inability to focus, insomnia, and other issues that accompany early sobriety

Question 13

Discuss the three population-level interventions used to prevent alcohol addiction

Answer 13

• Reducing supply: Taxation/pricing, age limits, licensing of outlets, control of trading hours
• Reducing demand: Advertising controls, education, building ‘resilience’, treating mental health problems
• Reducing harm: thiamine fortification of bread, random breath testing

Question 14

List the effects of alcohol on the oral cavity

Answer 14

• OH impairment
• Increased risk for caries
• More likely to smoke = more oral issues
• Sialadenitis: decreased production of saliva
• Increased cancer risk
• Alcohol has drug interactions
• Alcohol decreases kidney filtration = renal toxicity of drugs
• May interfere with pain management