Alcohol dependence

Question 1

How common is it

Answer 1

• 4% people between 16-65yrs

- Binge drinking v common

Question 2

Who gets it

Answer 2

M>F for alcohol related death

Question 3

What are some risk factors

Answer 3

• Runs in families parent w/ alcoholism
• +15 drinks per week if male
• +12 drinks per week if female
• Mental health problems anxiety, depression, schizophrenia
• Young adult peer pressure
• High stress

Question 4

What is the presentation

Answer 4

• Alcohol withdrawal symptoms –> hyperactivity, anxiety, coarse peripheral tremor
• mild pyrexia, tachycardia, HTN
• Sweating, nausea, retching
• Seizures
• Auditory + visual hallucinations

Question 5

What are the signs

Answer 5

• malnourishment
• Signs of acute withdrawal symptoms
• Liver disease –> hepatomegaly (NB in chronic alcoholic liver disease, liver = shrunken)
• Ascites - gonadal atrophy
• AF + cardiomyopathy
• Pancreatitis
• Wernicke-ataxia, thiamine deficiency, confusion, opthalmoplegia

Question 6

What are the investigations

Answer 6

• What is consumption? DO they depend on a drink a day? What time if first drink? Has anyone raised concerns?
• Severity of Alcohol Dependence Questionnaire (SADQ) assess if score +15 o AUDIT test
• FBC – clotting screen, renal testing + LFTs
  - If MCV or platelet count or liver enzymes
• Gamma –GT best indicator of excessive alcohol consumption
• Fasting glucose chronic pancreatitis can DM

Question 7

What is the treatment for

Answer 7

• Advice/support groups AA
• Cognitive behavioural therapy
• Community based detoxification +15 units a day or those who score +20 on AUDIT test

PHARM

• Benzodiapines reduce tremor + agitation
• Vit B complex treat Wericke-Korsakoff syndrome
• B-Blockers –> reduce autonomic hyperactivity
• Drugs to prevent relapse –> Ca acetyl homotaurinate blocks GABA + NMDA receptor decrease craving