Alcohol Dependence Flashcards
Definitions:
- The problem drinker:
=> causes or experiences physical, psychological and/or self harm because of a drinking problem
=> often heavy drinkers but not always addicted to drinking - Heavy drinkers:
=> drink significantly more in quantity or frequency than is safe
- Binge drinkers:
=> drink excessively in short bouts with long periods of abstinence
=> overall weekly/monthly alcohol intake may be moderate - Alcohol dependence:
=> physical dependence or addiction to alcohol
Epidemiology:
=> 20% of men ; 10% of women drink more than double the recommended alcohol limit
=> Alcohol consumption is increasing in the UK
=> 1 in 5 male admissions to the acute medical wards is directly or indirectly due to alcohol
INFO CARD
What are the behavioural effects of alcohol?
With increasing alcohol concentration in blood:
=> impaired coordination, euphoria
=> ataxia, poor judgement, labile mood
=> marked ataxia, slurred speech, poor judgement, labile mood, nausea & vomiting
=> stage 1 anaesthesia, memory lapse, labile mood
=> respiratory failure, coma, death
What are the common alcohol related psychological problems?
=> Depression & anxiety
=> Memory problems
=> Delirium tremens
=> Attempted suicide
=> Suicide
=> Pathological jealousy
What are the common alcohol related social problems?
=> Domestic violence
=> Marital / sexual difficulties
=> Child abuse
=> Employment / financial problems
=> Accidents at home, on the roads, at work
=> Delinquency / crime
=> Homelessness
Alcohol related physical problems:
CNS:
=> Epilepsy
=> Werinke-Korsakoff syndrome
=> Polyneuropathy
CVS: => Cardiomyopathy => Beriberi heart disease => Cardiac arrhythmias => Hypertension
Metabolism: => Hyperuriceamia (gout) => Hyperlipidaemia => Hypoglycaemia => Obesity
Endocrine:
=> Pseudo-cushing’s syndrome
Respiratory system:
=> Chest infections
GI: => Acute gastritis => Oesophagus / large bowel carcinoma => Pancreatic disease => Liver disease i.e. fatty liver, hepatitis, cirrhosis
Haemopoiesis:
=> Macrocytosis (due to direct toxic effect on bone marrow or folate deficiency)
=> Thrombocytopenia
=> Leucopenia
Bone:
=> Osteoporosis
=> Osteomalacia
Muscles:
=> Acute or chronic myopathy
How many people become alcohol dependent?
25% of alcohol misuse => chronic alcohol dependence
Alcohol dependence syndrome builds up ~10 years of heavy drinking (3-4 years in women)
Symptoms of alcohol dependence:
=> Inability to keep to a drink limit
=> Difficulty avoiding getting drunk
=> Spending a considerable amount of time drinking
=> Missing meals
=> Memory lapses, blackouts
=> Restlessness without drink
=> Organising the day around drink
Symptoms of alcohol dependence:
=> Trembling after drinking the day before
=> Morning retching and vomiting
=> Sweating excessively at night
=> Withdrawal fits
=> Morning drinking
=> Increased tolerance
=> Hallucinations, frank delirium tremens
What is the diagnostic criteria for alcohol withdrawal symptoms?
Any 3 of the following:
=> Tremor of outstretched hands, tongue or eyelids
=> Sweating
=> Nausea, retching, vomiting
=> Tachycardia or hypertension
=> Anxiety
=> Psychomotor agitation
=> Headache
=> Insomnia
=> Malaise ; weakness
=> Tranient visual, tactile or auditory hallucinations
=> Grand mal convulsions
What is alcohol tremens?
Alcohol tremens = the most serious withdrawal state and occurs 1-3 days after alcohol cessation.
Symptoms: => disorientated => agitated => marked tremor => visual hallucination
Signs: => sweating => tachycardia => tachypnoea => pyrexia
Complications: => dehydration => Wernicke-korsakoff syndrome => infection => hepatic disease i.e. cirrhosis
What are the underlying aetiology theories behind alcohol dependence?
Genetics:
=> Genetic markers i.e. serotonin transporter gene, dopamine-2 receptor allele A1, alcohol dehydrogenase subtypes and monoamine oxidase B activity
Environment:
=> Adverse childhood experience increases risk of alcohol dependence
=> History of parental alcohol dependence / other substance abuse
Neurobiological:
Evidence for involvement of
=> dopaminergic and opiodergic neural circuitry
=> within the striatum and ventral tegmentum may be implicated in addiction
What is the psychological management for alcohol dependence?
Successful identification at an early stage:
=> Motivational enhancement
=> Feedback
=> Education about adverse effects
=> Agreed drinking goals
Motivational approach is based on 5 stages of change: => Pre-contemplation => Contemplation => Determination => Action => Reflective listening
This, along with CBT and 12-step facilitation used by Alcoholics Anonymous => reduce harmful drinking
Addicted drinkers experience difficulty stopping alcohol. Withdrawal symptoms makes it difficult and delirium tremens needs urgent treatment.
How do you treat delirium tremens in an alcohol dependent patient trying to give up alcohol?
General:
=> Admit to medical bed
=> Correct electrolytes and dehydration
=> Treat any co-morbid disorder e.g. infection
=> Give parental thiamine slowly (250mg daily for 3-5d) with Wernicke-Korsakoff’s encephalopathy
=> Prophylaxis phenytoin or carbamazepine if previous hx of withdrawal fits
Specific drug treatment:
Give either:
=> Diazepam 10-20mg
=> Chlordiazepoxide 30-60mg
How do you treat alcohol withdrawal if there is no delirium tremens?
Treated in outpatients as long as patient attends daily for medications and monitoring.
What drugs are used in prevention of alcohol dependence?
- Naltrexone : opioid antagonist
=> reduces the risk of relapse into heavy drinking and the frequency of drinking - Acamprosate : acts on GABA, noradrenaline, serotonin receptors
=> reduces drinking frequency
*Neither drug helpful in maintaining abstinence
=> Effects of both enhanced when combined together with counselling
- Disulfiram : reacts with alcohol to cause unpleasant acetaldehyde intoxication and histamine release
- Oral thiamine : prevents Wernicke-Korsakoff syndrome in heavy drinkers and should ALWAYS be prescribed
