Alcohol Misuse Disorder Flashcards
How many units is a bottle of wine?
9 units
What is the max. alcohol consumption per week?
12- 14 units (F, M resp.)
What is “hazardous drinking”?
- pattern of alcohol consumption that increases the risk of HARMFUL consequences for the user
- drinking 14-35 units of alcohol for WOMEN
- 14-50 units for men
Why alcohol consumption differ across nations?
- depends on the average income of the person
- the culture of the people
What is meant by harmful drinking? (3)
- pattern of alcohol consumption that cause MENTAL and PHYSICAL damage
- > 35 units in women
50 units in men
What does alcohol dependence mean?
- cluster of behavioural, cognitive and physiological factors that contribute to the STRONG desire to drink
- diff. in controlling it
What does DSM IV state?
-describes TWO distinct disorders, alcohol ABUSE and alcohol DEPENDENCE, with specific criteria for each
What does DSM 5 involve?
-integrates the two DSM IV disorders, into a SINGLE disorder called alcohol use disorder (AUD); mild, moderate, severe.
How to screen for Alcohol misuse?
- with AUDIT (involves 10 qs)
- Alcohol Use Disorders Identification Test
What is the scale for alcohol withdrawal assessment?
CIWA-AR
Clinical Institute Withdrawal Assessment for Alcohol
What does Brief intervention involve?
F.R.A.M.E.S
- FEEDBACK (review problems experienced d.t alcohol)
- RESPONSIBILITY (pt. resp. for CHANGE)
- ADVISE (reduction or abstinence)
- MENU (alternative options for drinking)
- EMPATHY
- SELF-EFFICACY (encourage efficacy)
What are the symptoms of alcohol withdrawal?
- tremor, sweating, nausea, retching
- increased HR, BP, T*
- anxiety, agitation
- insomnia, nightmares
- Hallucinations (v.a.tactile)
- withdrawal seizures (0-48hrs)
- delirium tremens (48-72hrs)
What are signs of COMPLICATED alcohol withdrawal?
- SEIZURES
- HALLUCINOSIS
- delirium tremens
- Wernicke- Korsakoff $
What do you start the patients on after successful withdrawal from alcohol?
- Naltrexone
- Acamprosate
- Disulfiram
What is seen in the DSM 5 Criteria AUD?
A maladaptive pattern of SUB. use > clinically sign. IMPAIRMENT/distressed as manifested by 2/more (within 12-month period):
- alcohol often taken in larger AMOUNTS or over a longer period
- persistent, unsuccessful effort to CUT down
- craving to use alcohol
- a lot of time spent in activities to OBTAIN or use alcohol.
- recurrent alcohol use results in FAILURE to fulfil work obligations
- social, recreational or occup. activities GIVEN up
- alcohol use in hazardous situations
- continued alcohol use despite recurrent SOCIAL and INTERPERSONAL problems, PHYSICAL n Psychological probs
How is tolerance define as?
- need for increase in alcohol amounts for desired effects
- markedly DIMINISHED effect with continued use of SAME amount
How may alcohol withdrawal be featured as?
- characteristic withdrawal $ for alcohol
- closely related subst. is taken to RELIEVE withdrawal symptoms
What are the 5 elements of Alcohol dependence?
- Physical Withdrawal
- Affective withdrawal
- Withdrawal relief drinking
- Alcohol consumption
- rapidity of reinstatement
When is Brief intervention delivered after an AUDIT?
- when you score 8-14 or 15-19 on the AUDIT
What is one form of therapy to help people out of alcoholism?
- Motivational Enhancement Therapy > by expressing empathy > sidestep RESISTANCE > developing discrepancy between current behaviour and values > by building confidence
What are some psychosocial interventions for relapse?
- CBT
- MET
- 12 step facilitation Therapy
- family and couple therapy
What is used to treat alcohol withdrawal, in severe and moderate DEPENDENCE?
What are the issues with Chlordiazepoxide?
-Chlordiazepoxide
- high RELAPSE rate
- cognitive withdrawal, cumulative NEURONAL damage
- kindling effect (severity of withdrawal symptoms tends to increase FTER each withdrawal)
What is delirium tremens?
- coarse TREMOR
- confusion
- delusions
- hallucinations
When is Acamprosate best for the pt?
- if the pt is completely abstinent and compliant to the meds
What is thought to be the MOA of ACAMPROSATE?
- axn on GABA and glutamate transmission
corrects the NT imbalance; post withdrawal, reducing craving
What is the MOA of Naltrexone?
- blocks opioid receptors
- reducing the REWARDING effect mediated by endorphins
What is given as a psychological deterrent?
- DISULFIRAM
> interaction with alcohol causes an unpleasant reaction (bad compliance)
> increased DOPAMINE transmission
