Alcohol and substance misuse

Question 1

Alcohol abuse.

a) Two screening investigations to assess severity of alcohol intake
b) Outline your management of a patient with alcohol misuse (acute and long-term)
c) Other than CAGE, give a more detailed questionnaire used in screening for alcohol problems. What does it assess?

Answer 1

a) MCV (macrocytosis), LFTs and gamma glutamyl transferase

b) - Obtain full history from patient and wife (separately if required)
- Do screening tests above
- Encourage patient acceptance of a problem before further help is given.

• For acute withdrawal: chlordiazepoxide
• psychological support.
• Long-term: self-help groups (AA), deterrent drugs, psychiatric help if required

c) Alcohol Use Disorders Identification Test (AUDIT): units per week, binge drinking, memory loss, behaviour, guilt, withdrawal, injury

Question 2

Acute alcohol withdrawal: pharmacological management

a) Acute - class. If seizures? Reduces what symptoms?
b) If WKS - also add?

Answer 2

a) Benzos (Chlordiazepoxide or diazepam),
IV lorazepam for seizures

b) IV Pabrinex (Vitamin B complex) and then oral thiamine and multivitamins

Question 3

Alcohol abstinence: pharmacological management

a) Two main drugs used post-detoxification
b) MoA for these two drugs
c) All drugs should be used in combination with…? (give 2 examples)

Answer 3

a) Acamprosate and naltrexone
b) - Acamprosate: •This blocks gamma-aminobutyric acid (GABA) and reduces N-methyl-D-aspartate (NMDA) receptor glutamate-related excitation. Reduces cravings
- Naltrexone: competitive antagonist of the opioid receptor which prevents the endogenous opioid from binding to the receptor, therefore giving reduction in the pleasurable effects from alcohol.
c) Psychological therapies (counselling, cognitive therapies, self-help: AA; and family support)