Alcohol Addiction Flashcards
What is the approximate prevalence of any alcohol disorder in the US? (including abuse and dependence)
17.6 million people (8.5%) - based on 2004 data
What percentage of people with an alcohol use disorder have received treatment?
20%
What sex, age, race is most likely to have an alcohol disorder?
2-3x more common in men.
Highest among young adults, rates decline with age.
Highest rates in Native Americans, Whites, Latinos, Blacks, Asians in descending order.
What are 4 indicators by which peopled get identified as having a problem with EtOH?
Family complaints (earliest) Work problems Medical problems (often late) Arrests (DWI, domestic disturbances)
What are the 4 DSM-IV-TR criteria for alcohol abuse? How many must you have to get the diagnosis? Time frame?
EtOH use with impairment or distress over 12mo period. Need at least 1 of these:
- Failure to fulfill obligations at work/school/home.
- Recurrent use in hazardous situations.
- Legal problems related to EtOH.
- Continued use despite EtOH-related social/interpersonal problems.
What are the 7 DSM-IV-TR criteria for alcohol dependence? How many must you have to get the diagnosis?
Must have at least 3 of the following:
- Tolerance.
- EtOH withdrawal signs/symptoms.
- Drinking more than intended.
- Unsuccessful attempts to cut down on use.
- Use despite physical or psychological consequences.
- Excessive time spent on EtOH.
- Impaired social/work activities due to EtOH.
What’s “alcohol dependence with physiological dependence” in the DSM-IV-TR?
Alcohol dependence with tolerance and/or withdrawal.
How does diagnosis alcoholism change in the DSM-V? What new criterion is added? Which is removed?
Alcohol Use Disorder is all on one spectrum, ranging from mild to moderate to severe depending on number of criteria met.
“Craving” EtOH is added as a criterion. Legal problems is removed.
When should you have a high index of suspicion for an alcohol use disorder?
All the time.
What percentage of the risk for having an alcohol use disorder is genetic?
50% of the risk for alcohol use disorder is genetic.
What are the 4 stages of treatment of alcohol use disorder?
- Identification.
- Detox / withdrawal
- Rehab
- Aftercare
4 parts of identification?
- Current drinking history: quantity, frequency, type.
- Has it ever caused a problem?
- Standardized screening tests (CAGE, AUDIT)
- Evaluate based on diagnostic criteria. Determine if patient wants to make change.
What’s are the questions in the CAGE questionnaire? What’s a positive response? What do you do with a positive response?
Positive response is answering yes to at least 2 of the following:
Have you ever felt you should CUT down on drinking?
Have people ANNOYED you by criticizing drinking?
Have you ever felt GUILTY about drinking?
Have you ever needed an EYE-OPENER (drink first thing in morning for nerves / hangover)?
Positive result isn’t diagnostic. It means further assessment is warranted.
What is the purpose of the AUDIT test?
It’s more for answering “Does this patient drink more than is healthy?” for early intervention.
Treatment for alcohol withdrawal?
Benzodiazepines, tapered over several days.
Mild symptoms of EtOH withdrawal?
Tremor, insomnia, anxiety, irritability, sweating, nausea, vomiting.
Severe symptoms of EtOH withdrawal?
Seizures, hallucinations, autonomic hyperactivity, DTs. These can be lethal!
How common is it for patients to need inpatient detox for EtOH?
Less than 10% of people with EtOH need it - but it’s important that they get it when they do.
4 goals of rehabilitation?
Enhance function
Increase motivation for abstinence
Restructure life without EtOH
Prevent relapse
Preferred treatment modality for rehab?
Psychosocial intervention + pharmacotherapy.
Is one form of psychosocial intervention shown to work better than the rest?
Not really. They all seem to work pretty well when people are motivated.
3 drugs approved for alcohol dependence?
Disulfiram (antabuse)
Naltrexone (ReVia/Vivitrol)
Acamprosate (Campral)
Why, practically, might disulfiram work?
It’s more that people are afraid of the getting sick when drinking - as opposed to getting sick from it and then not drinking.
(People put on ineffectively low dose of disulfiram remained abstinent better than people on full dose who were told it might be placebo).
Review: Disulfiram MoA?
Inhibits acetaldehyde dehydrogenase. Drinking -> instant terrible hangover.
Naltrexone MoA? Common result of treatment?
Opiate receptor antagonist. It takes away the positive effects of alcohol without making people sick. Prevents relapse to heavy drinking, but doesn’t promote abstinence.
Side effect profile of naltrexone?
As it’s blocking endogenous opiate agonists, it makes you feel a little crappy: nausea, headaches, fatigue, anxiety.
But it’s nothing severe.
According to professor (who consults for / is on advisory board for Alkermes, who makes Vivitrol), naltrexone should be given to every EtOH-dependent patient who can take it.
2 contraindications for naltrexone?
Current use of opioids -> can cause withdrawal or insufficient pain management.
Pregnancy or breastfeeding.
What is Vivitrol?
Injectable, 1x / mo, long-acting naltrexone contained in polylactide microspheres.
(seems pretty cool, but again, be aware of Dr. Kranzler’s conflict of interest here)
What’s weird about acamprosate efficacy?
It was worked well in European studies for EtOH use disorders, but these results can’t be replicated in the US.
Who can’t you use acamprosate in?
People with renal insufficiency. But you can use it in people with liver disfunction.
Is topiramate approved to treat alcohol dependence? MoA? Efficacy? Downside.
No, and it probably won’t be, as it’s off-patent. It’s an anticonvulsant. It appears to be effective. Lots of bad side effects.
