Alcohol Dependence

Question 1

What is classed as harmful alcohol use

Answer 1

Using the substance that causes damages to health

Persistent for at least 1 month or occurs repeatedly

Question 2

What is classed as dependence syndrome

Answer 2

Must have 3 or more of: 
Strong desire/ compulsion to drink 
Difficulty in controlling use 
Persistent use despite harm 
Preoccupation with drinking 
Increased tolerance 
Psychological withdrawal

Question 3

How is alcohol dependence treated

Answer 3

combination of treatment is needed
Must assess the trigger and any underlying social problems
Psychological support
Medical treatment to cope with side effects
Aim of initial treatment is to prevent seizures

Question 4

How do you assess alcohol dependence

Answer 4

FAST score - quick questionnaire
If score is above 3 move on to AUDIT scoring
This determines treatment
Can then do SADQ to determine severity

Question 5

What supportive treatments are available for alcohol dependency

Answer 5

oral thiamine - low risk
IM/IV pabrinex - high risk

Also important is nutrition, hydration, anti-emetics and anti-diarrhoeals

Question 6

What is delirium tremens

Answer 6

A medical emergency that occurs due to alcohol withdrawal
Usually appears 72-96 hours after last drink
Can last 1 week to 1 month Higher risk in high dependence & liver damage

Question 7

What are the symptoms of delirium tremens

Answer 7

Confusion, hallucinations, autonomic hyperactivity- tachycardia, sweating, HTN, pyrexia
Body tremors and seizures

Question 8

What is the management of delirium tremens

Answer 8

Inpatient detox
May be able to detain under common law
Give benzodiazepine to stop seizures
Pabrinex

Then give other supportive measures: anti-convulsant - psychotics, fluids et

Question 9

What is the triad for Wernicke’s encephalopathy

Answer 9

ophtalmoplegia (odd eye movement), ataxia, confusion

ataxia will settle with pabrinex

Question 10

What is Alcoholic Hallucinosis

Answer 10

Usually seen in chronic drinkers - in or after heavy drinking
Acoustic hallucinations, delusions, mood disturbances
Arising in clear consciousness
Should recover within 6 months, if not consider a psychotic illness

Question 11

How do you prevent a relapse

Answer 11

Pharmalogocal treatment such as Acamprosate and naltrexone (1st line) then disulfiram
Psychological help and intervention
Social rehabilitation