Alcohol Abuse Flashcards
What is alcohol abuse?
Alcohol abuse is the consumption of alcohol at a level sufficient to cause physical , psychiatric and/or social harm.
Binge drinking is drinking over twice the recommended level of alcohol per day, in one session ( >8 units for ♂ and >6 units for ♀).
Harmful alcohol use is defined as drinking above safe levels with evidence of alcohol-related problems ( >50 units/week for ♂ and >35 units/week for ♀).
What is the recommended alcohol intake for men and women per week?
Male: 14 units per week.
Female: 14 units per week.
The recommended limits used to be 3– 4 units per day (males) and 2– 3 units per day (females). However, guidance changed in January 2016 to 14 units per week, with no differentiation between men and women.
Briefly describe the pathophysiology and aetiology of alcohol abuse
Alcohol affects several neurotransmitter systems in the brain (e.g. its effect on GABA causes anxiolytic and sedative effects).
The pleasurable and stimulant effects of alcohol are mediated by a dopaminergic pathway in the brain. Repeated, excessive alcohol ingestion sensitizes this pathway and leads to the development of dependence.
Long-term exposure to alcohol 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of inhibitory neuronal GABA receptors and up-regulation of excitatory glutamate receptors, so when alcohol is withdrawn, it results in central nervous system hyper-excitability.
Patients with alcohol-use disorders often experience craving (a conscious desire or urge to drink alcohol). This has been linked to dopaminergic , serotonergic , and opioid systems that mediate positive reinforcement , and to the GABA , glutamatergic , and noradrenergic systems that mediate withdrawal.
The social learning theory suggests that drinking behaviour is modelled on imitation of relatives or friends. Operant conditioning states that positive or negative reinforcement from the effects of drinking will either perpetuate or deter drinking habits, respectively.
What % of the population drink over the recommended limits of alcohol?
Roughly 25% of ♂ and 15% of ♀ drink over the recommended level in the UK.
How common is alcohol dependence?
Alcohol dependence affects 4% of people between the ages of 16 and 65 in England.
What are the risk factors for alcohol abuse?
- Male
- Males are at increased risk of alcohol abuse and have increased metabolism of alcohol, thus allowing them to have higher quantities.
- Younger adults
- 16.2% among 18– 29 year olds; 9.7% among 30– 44 year olds have alcohol-related disorders
- Genetics
- Monozygotic twins have higher concordance rates than dizygotic
- Studies show increased risk of dependence in relatives of those affected
- Antisocial behaviour
- Pre-morbid antisocial behaviour has been found to predict alcoholism
- Lack of facial flushing
- The risk of alcoholism is ↓ in individuals who show alcohol-induced due to a mutation of gene coding for aldehyde flushing dehydrogenase so that it metabolizes acetaldehyde more slowly
- Commoner in some East Asian populations
- Life stressors
- E.g. financial problems, marital issues and certain occupations can increase the risk
What are the clinical features of alcohol intoxication?
Characterized by slurred speech, labile affect, impaired judgement and poor co-ordination.
In severe cases, there may be hypoglycaemia, stupor and coma.
What are the clinical features of alcohol dependence?
Edward and Gross Criteria
Note: SAW DRINk
- Subjective awareness of compulsion to drink
- Avoidance or relief of withdrawal symptoms by further drinking (also known as relief drinking)
- Withdrawal symptoms
- Drink-seeking behaviour predominates
- Reinstatement of drinking after attempted abstinence
- Increased tolerance to alcohol
- Narrowing of drinking repertoire (i.e. a stereotyped pattern of drinking – individuals have fixed as opposed to variable times for drinking, with reduced influence from environmental cues)
What are the clinical features of alcohol withdrawal?
Symptoms such as malaise, tremor, nausea, insomnia, transient hallucinations and autonomic hyperactivity occur at 6– 12 hours after abstinence. Peak incidence of seizures at 36 hours.
The severe end of the spectrum of withdrawal is also termed delirium tremens and the peak incidence is at 72 hours.
Briefly describe the ICD-10 Criteria for alcohol intoxication
A. General criteria for acute intoxication met:
- Clear evidence of psychoactive substance use at high dose levels;
- Disturbance in consciousness, cognition, perception or behaviour;
- Not accounted for by medical or mental disorder.
B. Evidence of dysfunctional behaviour:
- Disinhibition, argumentativeness, aggression, labile mood, impaired attention/concentration, interference with personal functioning
- One of following signs: unsteady gait, difficulty standing, slurred speech, nystagmus, flushing, ↓ consciousness and conjunctival injection
Briefly describe the ICD-10 Criteria for alcohol withdrawal
A. General criteria for a withdrawal state met:
- Clear evidence of recent cessation or reduction of substance after prolonged or high level usage;
- Not accounted for by medical or mental disorder.
B. Any three of the following: tremor, sweating, nausea/vomiting, tachycardia/ ↑ BP, headache, psychomotor agitation, insomnia, malaise, transient hallucinations and grand mal convulsions.
What are the medical effects of long term alcohol consumption?
Hepatic: fatty liver, hepatitis, cirrhosis and hepatocellular carcinoma.
Gastrointestinal: peptic ulcer disease, oesophageal varices, pancreatitis and oesophageal carcinoma.
Cardiovascular: hypertension, cardiomyopathy, arrhythmias.
Haematological: anaemia and thrombocytopenia.
Neurological: seizures, peripheral neuropathy, cerebellar degeneration, Wernicke’s encephalopathy, Korsakoff’s psychosis and head injury (secondary to falls).
Obstetrics: fetal alcohol syndrome.
What are the psychiatric effects of long term alcohol consumption?
- Morbid jealousy
- Self-harm and suicide
- Mood disorders
- Anxiety disorders
- Alcohol-related dementia
- Alcoholic hallucinosis
- Delirium tremens
What are the social effects of long term alcohol consumption?
- Domestic violence
- Drink driving
- Employment difficulties
- Financial problems
- Homelessness
- Accidents
- Relationship problems
What is delirium tremens? How does it present?
This withdrawal delirium develops between 24 hours and one week after alcohol cessation.
Peak incidence of delirium tremens is at 72 hours.
Physical illness is a predisposing factor.
Dehydration and electrolytic disturbances are a feature.
It is characterised by:
- Cognitive impairment
- Vivid perceptual abnormalities (hallucinations and/or illusions) Paranoid delusions
- Marked tremor
- Autonomic arousal (e.g. tachycardia, fever, pupillary dilatation and increased sweating)
What are the following signs?
Note: peripheral stigmata of chronic liver disease in alcoholics
A= palmar erythema
B= Dupuytren’s contracture
C= spider naevi
D= gynaecomastia
Other features include clubbing, caput medusa and oesophageal varices
What is one unit of alcohol?
Briefly describe the bio-psychosocial model for treating alcohol abuse
Briefly describe the management of alcohol dependence (long term)
Note: psychological
Motivational interviewing guides the person into wanting to change. Motivational interviewing is most effective during the pre-contemplation and contemplation phases.
CBT can be effective in managing alcohol problems and focuses specifically on alcohol-related beliefs and behaviours.
Alcoholics Anonymous (AA) is 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).
