Alcohol Abuse Flashcards
What are the criteria of alcohol abuse?
SAW DRINk
Subjective awareness of compulsion to drink
Avoidance / relief of withdrawal (relief drinking)
Withdrawal symptoms
Drink-seeking symptoms
Reinstatement of drinking after attempted abstinence
Increased alcohol tolerance
Narrowing of drinking repertoire (patterned type of drinking)
What are the ICD-10 criteria for alcohol intoxication?
General criteria:
1) clear evidence of psychoactive substance use at high dose levels
2) disturbance in consciousness
3) not accounted for by medical / mental disorder
+ Evidence of dysfunctional behaviour
What is the ICD-10 criteria for alcohol withdrawal?
General criteria:
1) clear evidence of recent cessation / reduction after prolonged / high use
2) not accounted for by medical / mental disorder
+ any three of physical symptoms
What is the questionnaire used to assess alcohol dependence?
C - have you ever felt you should Cut down your drinking?
A - have people Annoyed you by criticising your drinking?
G - have you ever felt Guilty about your drinking?
E - do you ever use alcohol as an Eye opener / Early in the morning?
What is the management for alcohol withdrawal?
Alcohol detoxification regime
High dose benzodiazepines
Thiamine (prevent Wernicke’s encephalopathy)
What is the management of alcohol dependence?
Pharmacological therapies (disulfiram, acamprosate, naltrexone)
Motivational interviewing
CBT
Alcoholics anonymous
What are the stages of change associated with recovering from alcohol dependence?
Pre-contemplation > Contemplation > (Resistance) < Preparation > Action > (Relapse) < Maintenance
Why is chlordiazepoxide used in alcohol misuse?
Detoxification
Benzodiazepines = binds to GABA (inhibitory neurotransmitter)
Alcohol v need for GABA & can lead to seizures, agitation, death
Why is diazepam used during a detoxification from alcohol?
Seizure control
PR
Why is zopiclone used during a detoxification from alcohol?
Sleep
Why is thiamine used in an alcohol detoxification?
Prevent Wernicke’s encephalopathy
What syndromes are associated with alcohol detoxification?
Wernicke’s encephalopathy / Wernicke-Korsakoff syndrome (confusion, ophthalmoplegia, ataxic gait - only present in 10% of cases)
> Korsakoff snydrome
Delirium tremens
= altered mental status (global confusion) and sympathetic overdrive (autonomic hyperactivity)
> Cardiovascular collapse (sudden death)
> Lilliputian hallucinations
What is Korsakoff syndrome?
Antegrade + retrograde amnesia
Confusion
> admission to nursing home
Why are alcoholics deficient of vitamin B?
Gastric mucosa = atrophied due to chronic inflammation > v IF > vitamin B deficiency
What is the MOA of disulfram?
> build up of acetaldehyde following alcohol consumption
unpleasant symptoms
=> abstinence due to classical conditioning
-ve = craving is still present, can be fatal when consumed with alcohol
