alcohol and addiction quiz

Question 1

• husband is worried about drinking
• stopped hobbies due to drinking
• needs to drink more than she used to to get the same effect
• feels strong compulsions to drink
• has had accidents while intoxicated

how likely is it that she has alcohol dependence

Answer 1

diagnostic threshold met for alcohol dependence

• CAGE screening tool

Question 2

what are the 6 criteria used to assess if someone has alcohol dependence

Answer 2

Cravings/compulsions to take
Difficulty controlling use
Primacy
Increased tolerance
Physiological withdrawal on reduction/cessation
Persistence despite harmful consequences

Question 3

What is the recommended maximum units of alcohol men and women can drink in one week?

Answer 3

14

• spread evenly over 3 days or more

Question 4

what alcohol screening test is the most accurate for pregnant women

Answer 4

TWEAK

Question 5

symptoms of acute alcohol withdrawal from 6-72 hrs

Answer 5

6-12 - nausea, shaking, insomnia, clammy, anxiety

12-24 - hallucinations

48-72 - delirium tremens (seizures, hallucinations), agitation, confusion, low grade fever

Question 6

drug treatment available for alcohol addiction

Answer 6

benzodiazepines - treatment for acute withdrawal

carbamazepine - anti-convulsant

disulfarim - aversion/deterrent effect

naltrexone - anti-craving

Question 7

managament of alcohol addiction

Answer 7

Thiamine replacement

Inpatient treatment if likely to be unsuccessful in community/seizures/delirium tremens/blackouts

if >15 units of alcohol per day, and/or who score ≥20 on the AUDIT, slowly taper alcohol intake (inpatient care?) via assisted alcohol withdrawal

First-line: benzodiazepines e.g. chlordiazepoxide. Lorazepam may be preferable in patients with hepatic failure. Typically given as part of a reducing dose protocol

Carbamazepine also effective in treatment of alcohol withdrawal (anticonvulsant)

Aversion/deterrant medication - Disulfiram

CBT, behavioural therapy, social network and environment-based therapies, group therapy

Maintenance of abstinence with anticraving drugs e.g. naltrexone or Acamprosat

Question 8

thiamine deficiency in alcohol addiction

Answer 8

nystagmus, ataxia, confusion
- urgent thiamine replacement

foetal alcohol spectrum disorders - in-utero exposure to alcohol leads to fetal brain dysfunction

Thiamin deficiency - neural membrane dysfunction, because thiamin is a structural component of mitochondrial and synaptosomal membranes

wernicke’s encephalopathy