Alcohol Misuse Disorders

Question 1

How common is alcohol consumption in the UK?

Answer 1

80% of the population consumes alcohol

1 in 4 people drinks more than 14 units/week

Question 2

How common is alcohol misuse disorder?

Answer 2

Lifetime prevalence is 7-10% in most Western countries
About 8% of all patients admitted to hospital are at risk of alcohol withdrawl
More common in men

Question 3

What is hazardous drinking?

Answer 3

Pattern of alcohol consumption that increases risk of harmful consequences for the user

Question 4

What is the criteria for hazardous drinking?

Answer 4

Drinking more than 14 units a wee but less than 35 units for women and less than 50 units for men

Question 5

What is harmful drinking defined as?

Answer 5

Pattern of alcohol consumption that is causing mental/physical damage = 35 units a week or more for women, and 50 units or more per week for men

Question 6

What is alcohol dependence?

Answer 6

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

Question 7

What is alcohol misuse disorder defined as under the DSM-5?

Answer 7

Maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 or more symptoms occurring at any time in the same 12 month period

Question 8

What are the symptoms of alcohol misuse disorder as defined under the DSM-5?

Answer 8

Alcohol taken in larger amounts or over longer period than intended
Persistent desire or unsuccessful efforts to control use
Great deal of time spent in activities necessary to obtain/use alcohol
Craving or urge to use alcohol
Recurrent use resulting in failure to fulfil major duties
Continued use despite persistent problems
Important activities given up/reduced due to use
Recurrent use in physically hazardous situations
Continued use despite knowledge of issues being caused by alcohol
Tolerance and withdrawl

Question 9

What is tolerance defined as?

Answer 9

A need for markedly increased amounts of alcohol to achieve desired effect
Markedly diminished effect with continued use of same amount of alcohol

Question 10

What is withdrawl defined as?

Answer 10

Characteristic withdrawl syndrome for alcohol

Alcohol diminished effect with continued use of same amount of alcohol

Question 11

What is the classification of alcohol misuse disorder?

Answer 11

Mild = presence of 2-3 symptoms
Moderate = presence of 4-5 symptoms
Severe = presence of 6 or more symptoms

Question 12

What is the Alcohol Use Disorders Identification Test (AUDIT)?

Answer 12

Comprehensive 10 question alcohol harm screening tool = each question scored from 0 to 4

Question 13

What is the Severity of Alcohol Dependence Questionnaire?

Answer 13

5 criteria assessed = physical withdrawl, affective withdrawl, withdrawl rrelief drinking, alcohol consumption, rapidity of reinstatement

Question 14

What is FRAMES?

Answer 14

System of brief interventions = feedback, responsibility, advice, empathy and self-efficacy

Question 15

What are the steps in FRAMES?

Answer 15

Review problems experienced because of alcohol and get patient to accept they are responsible
Advise reduction/abstinence and provide options for changing behaviour
Use empathetic approach and encourage optimism about changing behaviour

Question 16

What are the central principles of motivational enhancement therapy?

Answer 16

Express empathy by using reflective listening to convey understanding
Develop the discrepancy between their most deeply held values and their current behaviour
Sidestep resistance by responding with empathy and understanding rather then confrontation
Support self-efficacy by building confidence

Question 17

What are some psychosocial interventions use to prevent relapse?

Answer 17

CBT, motivational enhancement therapy, 12 step facilitation therapy, family and couple therapy

Question 18

What is the drug of choice for medically assisted detox?

Answer 18

Chlordiazepoxide

Question 19

What are the drawbacks of medically assisted detox?

Answer 19

High rate of relapse after successful withdrawl
Cognitive impairment and cumulative neuronal damage
Kindling effect

Question 20

What is the kindling effect that occurs in medically assisted detox?

Answer 20

Severity of withdrawl symptoms tends to increase after each alcohol withdrawl

Question 21

What are the symptoms of alcohol withdrawl syndrome?

Answer 21

Tremor, sweating, nausea, retching, increased heart rate/BP, anxiety, agitation, insomnia, nightmares

Question 22

What kind of hallucinations can occur in alcohol withdrawl syndrome?

Answer 22

Auditory, visual and tactile

Question 23

When do withdrawl seizures occur?

Answer 23

0-48 hrs from last drink

Question 24

What is delirium tremens?

Answer 24

Occurs 48-72 hrs after last drink = coarse tremor, confusion, delusions, hallucinations

Question 25

What are the features of a complicated withdrawl?

Answer 25

Seizures, hallucinations, delirium tremens, Wernicke-Korsakoff syndrome

Question 26

When is pharmacological treatment for alcohol misuse syndrome started?

Answer 26

After successful withdrawl = agents include acamprosate, naltrexone and disulfiram

Question 27

What are some features of acamprosate?

Answer 27

Acts on GABA and glutamate transmission
Corrects neurotransmission imbalance post-withdrawl
Reduces cravings

Question 28

What are some features of naltrexone?

Answer 28

Blocks opioid receptors

Reduces rewarding effect mediated by endorphin system

Question 29

What are some features of disulfiram?

Answer 29

Causes unpleasant and dangerous reaction when taken with alcohol = psychological deterrent
Anticraving effect through increased dopamine transmission
Low compliance and potentially rare but severe side effects