Alcohol and Substance Abuse

Question 1

What is the ICD-10 criteria of alcohol dependence?

Answer 1

At least 3 of the following in the last 12 months/1year:

• Intense desire to drink alcohol
• Difficulty in controlling the onset, termination and level of drinking
• Experiencing withdrawal symptoms if alcohol is not taken/Use of alcohol to relieve oneself from withdrawal symptoms
• Persisting with alcohol intake despite clear evidence and knowledge of its harm
• Tolerance as evidenced by the need to escalate dose over time to achieve the same effect
• Salience: neglecting alternate forms of leisure or pleasure in life

Question 2

What are the CAGE questions?

Answer 2

• Have you ever felt you needed to Cut down on your drinking?
• Have people Annoyed you by criticising your drinking?
• Have you ever felt Guilty about drinking?
• Eye-opener: Have you ever felt you needed a drink first thing in the morning to steady your nerves or to get rid of a hang-over?

Question 3

Which medication helps maintain alcohol aversion by causing patients to feel nauseated whenever they drink alcohol?

Answer 3

Disulfiram

Question 4

What is weed?

What other names are there for this drug?

Answer 4

Weed is Cannabis.

It is also known as Marijuana, Grass and Green

Question 5

What is the effect of heavy drinking during pregnancy?

Answer 5

Fetal alcohol syndrome.

This presents with facial abnormality, low weight, low intelligence and overactivity.

Question 6

What are the physical effects of excessive use of alcohol on the GI system?

Answer 6

Gastritis
Peptic ulcer
Oesophageal varices
Oesophageal carcinoma
Acute and chronic pancreatitis
Hepatitis and Cirrhosis

Question 7

What are the 3 neuropsychiatric disorders associated with excessive use of alcohol?

Answer 7

Korsakov’s syndrome
Wernicke’s encephalopathy
Alcoholic dementia

Question 8

Name the neuropsychiatric effect of excessive alcohol intake resulting in a withdrawal state.
Describe/Explain this condition.

Answer 8

Delirium Tremens.

Delirium Tremens is a rapid onset of confusion usually caused by withdrawal from alcohol.

Question 9

Who are usually affected by Delirium Tremens?

Answer 9

Delirium Tremens usually affect those who abruptly stop taking alcohol after excessive consumption of alcohol for more than a month.

Question 10

What are the signs and symptoms of Delirium Tremens?

Answer 10

Those seen in delirium such as:

• Clouding of consciousness
• disorientation in time and place
• impairment of recent memory
• agitation and fearfulness
• hallucinations: mostly visual and are often frightening
• dilatation of pupils, tachycardia, gross tremor of hands

Question 11

Are the symptoms of Delirium Tremens worse in the morning or at night?

Answer 11

The symptoms, as in other kinds of delirium, are characteristically worse at night.

Question 12

When will Delirium Tremens present itself, and how long does it usually last for?

Answer 12

Delirium Tremens present 3-10 days following the last drink.

It lasts for 3-4 days.

Question 13

What are the properties/effects of these drugs, given for maintenance of alcohol aversion/reduce risk of relapse:

• Naltrexone
• Disulfiram
• Acamprosate

Answer 13

Naltrexone is an opioid antagonist which blocks the positive effects of alcohol consumption.

Disulfiram blocks dehydrogenase in the liver and this causes vomiting whenever patient consumes alcohol.

Acamprosate decreases cravings