Alcohol and drug misuse and dependence Flashcards
What is alcohol misuse?
Drinking in a way that regularly causes problems to the patient or others
What are the classifications of alcohol misuse and dependence?
Problem drinker - one who causes or experiences physical, psychological and/or social harm as a consequence of drinking alcohol
Heavy drinker - drinking significantly more in terms of quantity and/or frequency than is safe in the long term
Binge drinker - excessively drinking in short bouts separated by quite long lengths of abstinence
Alcohol dependence - physical dependence or addiction to alcohol
What are the screening questions for alcohol addiction called?
CAGE
AUDIT-C
What are the questions in CAGE?
Have you ever felt that you should CUT down on your drinking?
Have people ever ANNOYED you by criticising your drinking?
Have you ever felt bad or GUILTY about your drinking?
Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? (EYE OPENER)
Score over 2 = problematic drinking
What are the questions in AUDIT-C?
How often do you have a drink containing alcohol? - Never 0 - Monthly or less 1 - 2-4 times per month 2 - 2-3 times a week 3 - 4 or more times a week 4 How many units of alcohol do you drink on a typical day when you are drinking? - 1 or 2 - 0 - 3 or 4 - 1 - 5 or 6 - 2 - 7 to 9 - 3 - 10 or more - 4 How often have you had 6 or more units if female, or 8 or more if male on a single occasion in the last year? - Never 0 - Less than monthly 1 - Monthly 2 - Weekly 3 - Daily or almost daily 4 3 or more out of 12 then ask the full audit questionnaire
What is also important to ask in an alcohol history?
When did you first notice an increase in the amount of alcohol you were drinking?
Anything going on at the time to play a role in this?
How often do you drink?
How much do you drink on an average day?
Where and who do you drink with?
Have you tried to stop drinking before?
What happened? Support?
What may you find in a physical examination that may demonstrate alcohol dependence?
Tremors Sweating N&V Tachycardia/hypertension Anxiety Psychomotor agitation Headache Insomnia Malaise and weakness Transient visual, tactile, or auditory hallucinations or illusions Generalised tonic-clonic convulsions
Name 3 risk factors for alcohol misuse
Mental health disorders - EUPD, depression, anxiety, schizophrenia, mania
Binge drinking
Abuse
Parents with a history of alcoholism
How common is alcohol misuse?
20% men and 10% women drink more than recommended 3 units per day
Amount of alcohol consumed has doubled in the UK over the last 50 years
2-3 times risk of dying that the general population
1 in 5 male admissions directly/indirectly due to alcohol
What conditions could alcohol misuse been seen as a self-treatment for?
GAD Social phobia Dysthymic disorder Major depression Bipolar mania Insomnia
How does alcohol dependence present?
Unable to limit the amount they drink Difficulty in avoiding getting drunk Spending a lot of time drinking Missing meals Memory lapses, blackouts Restlessness without a drink Trembling after drinking the day before Morning retching and vomiting Sweating excessively at night Withdrawal fis Morning drinking Increased tolerance Hallucinations Delirium tremens
What genetic factors could cause alcohol misuse?
Serotonin transporter gene
D2 receptor allele A1
Alcohol dehydrogenase subtypes
MAO B activity
What environmental factors could cause alcohol misuse?
Childhood maltreatment
Parental alcohol dependence
Other substance misuse
What biochemical factors could cause alcohol misuse?
Abnormalities in alcohol dehydrogenase
Neurotransmitter substances
Brain amino acids (GABA)
What else could lead to alcohol misuse?
Excess consumption in the community
What could you do to diagnose alcohol dependence?
Questionnaires - over 36 units per week poses long term health risks
Bloods - elevated gamma-GT and MCV
Blood and breath alcohol tests
How do you manage alcohol dependence?
Motivational therapy
Psychological treatment
Admission
Correct electrolyte abnormalities and dehydration
Treat other disorders
Thiamine (more if have Wernicke’s)
Phenytoin/carbamazepine if previous history of withdrawal fits
Diazepam/chlordiazepoxide
Additional benzodiazepine if symptoms and signs not controlled
How can you prevent alcohol dependence relapse?
Naltrexone
Acamprosate
Disulfiram
What is the prognosis of alcohol dependence?
30-50% of alcohol dependent drinkers abstinent or drinking much less up to 2 years following additional intervention
What are the risks of alcohol?
Alcohol dependence
Alcohol poisoning
Wernicke’s encephalopathy/Korsakoff’s sydrome
Sleep problems
Effects on day-to-day life - relationships, occupation, diet, alcohol-related crime
Dangers to attacking his wife/other family members
Injuries from alcohol - car accidents
Other medical problems - heart problems, gut problems, pancreatitis, cancers - oral, laryngeal, oesophageal, colon, pancreatic, hepatic, small intestine, liver disease, diabetes
Weight gain
Mental health problems - depression, suicidal thoughts
What are the risks of suddenly stopping drinking?
Delirium tremens
Seizures
Alcohol withdrawal
Wernicke’s encephalopathy and Korsakoff’s - loss of mammillary bodies
