Alcohol addiction

Question 1

What is hazardous/harmful/problem drinking? (interchangeable terms)

Answer 1

Excess intake causing actual or potential harm, but no dependence

Question 2

What is alcohol abuse?

Answer 2

Repeated drinking causing harm to work or social life

Question 3

What 5 things mean alcohol dependence/addiction?

Answer 3

Increased tolerance, narrowed repertoire, withdrawal, difficulty/failure of abstinence, priority to maintain alcohol intake

Question 4

Give 3 screening tools. What are the first two’s main drawback?

Answer 4

CAGE (>2 implies problem drinking), TWEAK (modified CAGE that includes tolerance). These two do not assess dependence or abuse, just that there is problem drinking. AUDIT – used to identify risk and offer advice.

Question 5

Give 2 blood tests to screen and 2 blood tests to look at in alcohol withdrawal.

Answer 5

Gamma GT, MCV (macrocytic anaemia)

Question 6

When should alcohol withdrawal be considered? How long does it take to start?

Answer 6

In EVERY new patient who is confused. Takes around 3 days after stopping drinking

Question 7

Give 5 features. When is withdrawal Delirium tremens?

Answer 7

Increased pulse, low BP, tremor, seizures, visual or tactile hallucinations (i.e. formication) – hallucinations = delirium tremens

Question 8

What is treatment for alcohol withdrawal?

Answer 8

Chlordiazepoxide or diazepam (2nd line)

Question 9

What is Wernicke’s encephalopathy? Asides from alcohol dependence, give 3 causes

Answer 9

Medical emergency caused by thiamine (B1) deficiency. Eating disorders, malabsorption, brain tumours.

Question 10

What is the clinical triad of Wernickes?

Answer 10

Confusion, wide based gait ataxia, ophthalmoplagia (nystagmus, conjugate gaze, bilateral CNVI palsies)

Question 11

Give 5 other potential clinical features of Wernickes

Answer 11

Clouding of consciousness, memory disturbance, peripheral neuropathy, hypotension, hypothermia, ptosis.

Question 12

How is Wernickes treated and what is the prognosis?

Answer 12

High dose IV/IM thiamine then PO. Prognosis: 20% die untreated, 80% ish get Korsakoff’s

Question 13

What is Korsakoff’s syndrome?

Answer 13

Long-term thiamine deficiency. Leads to hypothalamic damage and cerebral atrophy

Question 14

Give 3 clinical features of Korsakoffs and the prognosis

Answer 14

Confabulation, inability to acquire new memories, lack of insight. ¼ are reversible but even so, a slow and often incomplete recovery

Question 15

What therapy can help w alcohol dependence?

Answer 15

Group therapy.

Question 16

Give 2 medications that can help with managing dependence?

Answer 16

Disulfiram, naltrexone (opioid antagonist, helps ½ relapse rates)

Question 17

Give 5 lifestyle measures for alcohol dependence

Answer 17

Slow down how fast you drink, don’t buy yourself a drink at rounds, go to the pub later, rewards for sobriety, alcohol diary

Question 18

What problems does alcohol cause to the liver? CNS? GI? CVS?

Answer 18

Liver: Normal in 50%! Fatty liver hepatitis (10% get liver failure)  80% get cirrhosis with hepatitis. 50% 5 year survival if keep on drinking, 80% if not.
CNS: Wernicke’s, Korsakoff’s, cortical and cerebellar atrophy, peripheral neuropathy.
GI: Pancreatitis, varices, ulcers
CVS: Arrhythmias, cardiomyopathy

Question 19

Give 2 cancers linked to alcohol.

Answer 19

Breast and bowel

Question 20

What is a unit? Give 3 examples.

Answer 20

8g pure ethanol. 25ml spirit, 1 glass of wine, ½ pint of standard strength beer

Question 21

What is the recommended weekly limits for men and for women?

Answer 21

14

Question 22

What is binge drinking? How many people does it affect?

Answer 22

> 8U/day or >6U/day for men and women respectively. Effects 20% of men, 10% women