Alcohol Disorders

Question 1

how much is 1 unit of alcohol?

Answer 1

10mls

8g

Question 2

alcohol guidelines?

Answer 2

14 units per week for men and women

Question 3

how many people drink at hazardous levels (over 14 units per week)?

Answer 3

1 in 4

Question 4

what is hazardous drinking?

Answer 4

pattern of alcohol consumption that increases the risk of harmful consequences for the user
more than 14 units but less than 35(women)/50(men) units per week

Question 5

what is harmful drinking?

Answer 5

pattern of alcohol consumption that is causing mental or physical damage
>35 units per week (women)
>50 units per week (men)

Question 6

what is alcohol dependence?

Answer 6

cluster of behavioural, cognitive and physiological factors that typically includes a strong desire to drink alcohol and difficulties controlling its use

Question 7

how does DSM 5 classify alcohol use?

Answer 7

combines alcohol abuse and dependence into single disorder - alcohol use disorder

• mild (2-3 symptoms)
• moderate (4-5 symptoms)
• severe (6+ symptoms)

Question 8

DSM 5 criteria for alcohol use disorder?

Answer 8

maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by 2 or more of the following occuring at any time in the same 12 month period

Question 9

2 of what 9 behaviours are required for alcohol use disorder diagnosis via DSM 5?

Answer 9

1. alcohol often taken in larger amounts or over a longer period than was intended
2. persistent desire or unsuccessful efforts to cut down or control alcohol use
3. great deal of time spent in activities necessary to obtain alcohol, use alcohol or recover from its effects
4. craving or a strong desire or urge to use alcohol
5. recurrent alcohol use resulting in a failure to fulfil major role obligations at work, school or home
6. continued alcohol use despite persistent or recurrent social/interpersonal problems
7. important social, occupational or recreational activities are given up or reduced because of alcohol use
   - recurrent alcohol use in situations in which it is hazardous
8. alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem due to alcohol

Question 10

DSM tolerance definition?

Answer 10

need for markedly increased amounts of alcohol to achieve intoxication or desired effect
markedly diminished effect with continued use of the same amount of alcohol

Question 11

withdrawal DSM definition?

Answer 11

characteristic withdrawal syndrome for alcohol

alcohol or related substance (benzodiazepines) taken to relieve or avoid withdrawal symptoms

Question 12

what is AUDIT?

Answer 12

alcohol use disorders identification test

10 question alcohol harm screening tool developed by WHO

Question 13

the severity of alcohol dependence questionnaire measures which 5 elements of alcohol dependence?

Answer 13

physical withdrawal
affective withdrawal
withdrawal relief drinking
alcohol consumption
rapidity of reinstatement

Question 14

what is CIWA-AR?

Answer 14

clinical institute withdrawal assessment for alcohol

10 item scale used in assessment and management of alcohol withdrawal

Question 15

FRAMES for brief intervention?

Answer 15

feedback (review problems)
responsibility (patient is responsible for change)
advice (advice reduction or abstinence)
menu (provide options for changing behaviour)
empathy
self efficacy (encourage optimism about changing behaviour)

Question 16

stages of change?

Answer 16

pre-contemplation > contemplation > planning > action > maintenance > relapse > pre-contemplation etc

Question 17

psychosocial interventions to prevent relapse?

Answer 17

CBT
motivational enhancement therapy
12 step facilitation (eg AA)
family and couple therapy
project MATCH

Question 18

main drug used in medical assisted alcohol detox and what are the risks of this?

Answer 18

chlordiazepoxide
tends to have high relapse rate after successful medical withdrawal
can cause cognitive impairment and neuronal damage

Question 19

features of alcohol withdrawal syndrome?

Answer 19

Tremor, sweating, nausea, retching
Increased HR, BP, T
Anxiety, agitation
Insomnia, nightmares
Auditory, visual, tactile hallucinations
Withdrawal seizures (0-48 hours)
Delirium tremens (48-72 hours) coarse tremor, confusion, delusions, hallucinations

Question 20

what can happen in complicated withdrawal?

Answer 20

seizures
hallucinosis
delirium tremens
wernicke koraskoff syndrome

Question 21

what drugs can be used for relapse prevention?

Answer 21

acamprosate (acts on GABA and glutamate transmission to correct balance)
naltrexone (blocks opioid receptors and reduced reward effect mediated by endorphin system)
disulfiram (causes unpleasant reaction when combined with alcohol)