Alcohol Misuse Disorders Flashcards
how many mls is equal to 1 unit of alcohol?
10mls
approx what % of patients admitted to hospital are at risk of alcohol withdrawal?
8
what is hazardous drinking?
a pattern of alcohol consumption that increases the risk of harmful consequences for user
women - 14-35 units
men - 14-50 units
what is harmful drinking?
a pattern of alcohol consumption that is causing mental or physical damage
women - >35 units
men - >50 units
what is alcohol dependence?
a cluster of behavioural, cognitive and physiological factors that typically include a strong desire to drink alcohol and difficulties in controlling its use
DSM 5 criteria defines alcohol use disorder as a maladaptive pattern of substance use leading to clinically significant impairment or distressed, manifested by 2 or more of what symptoms occurring at any time in same 12 months?
alcohol taken in larger amounts or for longer than intended
persistent desire or unsuccessful efforts to cut down
a great deal of time spent in activities to obtain alcohol, use alcohol or recover from its effects
craving or strong desire to use alcohol
recurrent alcohol use resulting in failure to fulfil major role obligations at work, school or home
continued alcohol despite persistent social or interpersonal problems caused or exacerbated by it
important social, occupational or recreational activities given up
recurrent alcohol use in situations in which it is physically hazardous
alcohol use continued despite knowledge of persistent or recurrent physical or psychological problems
what does the DSM 5 criteria define as tolerance?
a need for markedly increased amounts of alcohol to achieve intoxication or desired effect
a markedly diminished effect with continued use of same amount
the DSM 5 criteria states that withdrawal manifests as what?
either the characteristic withdrawal syndrome for alcohol or alcohol (or related eg benzo) is taken to relieve or avoid withdrawal symptoms
how many symptoms are in the following?
a) mild alcohol use disorder
b) moderate alcohol use disorder
c) severe alcohol use disorder
a) 2-3 symptoms
b) 4-5 symptoms
c) 6 or more symptoms
what is the alcohol use disorders identification test (AUDIT)?
comprehensive 10 question alcohol harm screening tool, developed by WHO
what five elements does the severity of alcohol dependence questionnaire measure?
physical withdrawal affective withdrawal withdrawal relief drinking alcohol consumption rapidity of reinstatement
what is ten item scale used in the assessment and management of alcohol withdrawal?
clinical institute withdrawal assessment for alcohol (CIWA-AR)
what would you do for the following results of AUDIT?
a) 0-7 = low risk drinking
b) 8-14 = hazardous drinking
c) 15-19 = harmful drinking
d) 20+ = possible dependence
a) reinforce current drinking patterns
b) deliver brief intervention
c) brief intervention -> motivational enhancement therapy sessions -> consider prescribing options
d) comprehensive assessment
what 6 elements (summarised by acronym FRAME) are commonly included in brief interventions that have been shown to be effective?
feedback - review problems experienced because of alcohol
responsibility - pt responsible for change
advice - advice reduction or abstinence
menu - provide options for change
empathy - use empathic approac
self-efficacy - encourage optimism
what is motivational enhancement therapy?
express empathy by using reflective listening to convey understanding
develop discrepancy between their most deeply held values and their current behaviour
sidestep resistance by responding with empathy and understanding rather than confrontation
support self efficacy by building confidence that change is possible
what psychological interventions can be used for relapse prevention?
CBT
motivational enhancement therapy
12 step facilitation therapy (eg AA)
family and couple therapy
what is the drug of choice for medical assisted detoxification?
chlordiazepoxide - well tolerated
what are the problems with chlordiazepoxide?
high rate of relapse
cognitive impairment, cumulative neuronal damage
kindling effect (the severity of withdrawal symptoms tend to increase after each alcohol withdrawal)
what are the symptoms of alcohol withdrawal syndrome?
tremor, sweating, nausea, retching
increased HR, BP
anxiety, agitation
insomnia, nightmares
auditory, visual, tactile hallucinations
withdrawal seizures (0-48 hours)
delirium tremens (48-72 hours) - course tremor, confusion, delusions, hallucinations
what are symptoms of complicated withdrawal?
seizures
hallucinosis
delirium tremens
wernicke-korsakoff syndrome
what drugs are licensed to prevent relapse after successful withdrawal?
acamprosate
naltrexone
disulfiram
how does acamprosate work?
action on GABA and glutamate transmission, corrects the neurotransmission imbalance post withdrawal and reduces craving
how does naltrexone work?
blocks opioid receptors - reduces rewarding effect mediated by endorphin system
how does disulfiram work?
if mixed with alcohol, causes unpleasant and dangerous reaction so this is psychological deterrant
anti craving effect through increased dopamine transmission
what is the problem with disulfiram?
potential rare but severe side effects
non-compliance
