Alcohol Use Disorder Flashcards
Alcohol
A legal, psychoactive substance
What about binge drinking?
● Evidence suggests that binge drinking is linked to negative impacts on the
liver, the brain, cancer, and cardiovascular health
● In some cases, the impacts of binge drinking are no different than drinking the
same amount over a longer period of time
● Binge drinking is also linked with higher rates of behaviors that put people’s
health at risk (for example, smoking)
Canada’s Guidance on Alcohol and Health
ok
Screening
High risk drinking often goes unrecognized and untreated
● Universal screening is key
● Important to introduce tools in a non-judgmental, conversational manner
○ Consent is important
● Several tools exist - some examples include CAGE, AUDIT-C
● Screening alone is not enough
○ Does not improve outcomes
AUDIT-C
- how often do you have a drink containing alcohol?
- how many units of alcohol do you drink on atypical day when you are drinking
- how often do you have 6+ drinks on one occasion
CAGE
● Have you ever felt you should cut down on drinking?
● Have other people annoyed you by criticizing your drinking?
● Have you ever felt guilty about your drinking?
● Have you ever taken a drink in the morning to steady your nerves or to get rid
of a hangover? (eye-opener)
Yes x 2 - 84% sensitivity, 85% specificity
Brief Interventions
● To support behavioral change to reduce alcohol consumption
● A variety of approaches exist - what is consistent is that they include a brief
variant of motivational interviewing
○ Helps develop motivation to change; therapeutic alliance between patient and provider
the 5As model for delivering alcolhol use brief interventions
ask
advise
assess
assist
arrange
DSM 5 - Alcohol Related Disorders
Alcohol use disorder
● Mild
● Moderate
● Severe
Alcohol induced disorders
● Alcohol intoxication
● Alcohol withdrawal
● Other alcohol induced mental
disorders
○ Includes: anxiety disorder, sleep
disorders, depressive disorder,
psychotic disorder, bipolar
disorder, etc.
DSM 5 - Alcohol intoxication
● Recent ingestion of alcohol
● Clinically significant problematic behavioural or psychological changes (eg.
inappropriate sexual or aggressive behaviour, mood liability, impaired
judgement) that developed during, or shortly after alcohol ingestion
One or more of the following signs or symptoms developing during, or shortly after,
alcohol use:
● Slurred speech
● Incoordination
● Unsteady gait
● Nystagmus
● Impairment in attention or memory
● Stupor or coma
The signs and symptoms are not attributable to another medical condition and are
not better explained by another mental disorder (including intoxication with another
substance)
Intoxication - Clinical Presentation
● Slurred speech
● Ataxia
● Nystagmus
● Sedation
● Flushed face
● Mood changes
● Irritability
● Euphoria
● Decreased attention
Blood alcohol level
5 mg/dL - legally impaired (equivalent to
0.05%)
10 mg/dL - significant impairment
20 mg/dL - impaired ability to walk
30 mg/dL - loss of consciousness
40 mg/dL - respiratory arrest, coma, death
DSM 5 - Alcohol use disorder
A problematic pattern of alcohol use leading to clinically significant impairment or
distress, as manifested by at least two of the designated criteria, occurring within
a 12-month period
Alcohol is often taken in larger amounts or over a longer
period of time than intended
Important social, occupational, or recreational activities are
given up or reduced due to alcohol use
Persistent desire or unsuccessful efforts to reduce or control
alcohol use
Continued use despite persistent or recurrent social or
interpersonal problems caused or exacerbated by effects of
alcohol
Significant amount of time is spent in activities necessary to
obtain, use, or recover from alcohol
Continued use despite knowledge of having persistent or
recurrent physical or psychological problem that is likely
caused or exacerbated by alcohol
Craving, or a strong desire to use alcohol
Tolerance - defined as either of the following:
● A need for markedly increased amounts of alcohol to
achieve intoxication or desired effect
● Markedly diminished effect with continued use of same
amount of alcohol
Recurrent alcohol use resulting in failure to fulfill major role
obligations at work, school, or home
Withdrawal - manifested as either of the following:
● Characteristic alcohol withdrawal syndrome
● Alcohol (or a closely related substance, such as a
benzodiazepine) is taken to relieve or avoid withdrawal
symptoms
Recurrent use in situations in which it is physically hazardous
DSM 5 - Alcohol Withdrawal
A. Cessation of (or reduction in) alcohol use that has been heavy and prolonged
B. Two (or more) of the following, developing within several hours to a few afters
after Criterion A
○ Autonomic hyperactivity
○ Increased hand tremor
○ Insomnia
○ Nausea or vomiting
○ Transient visual, tactile, or auditory hallucinations or illusions
○ Psychomotor agitation
○ Anxiety
○ Grand mal seizures
Alcohol withdrawal
Time from alcohol cessation Symptoms of withdrawal
<6 - 12 hours ● Hand tremors
● Nausea, vomiting
● Mild agitation
● Anxiety
● Insomnia
● Headache
● Diaphoresis
12 - 24 hours Alcohol hallucinosis:
● Transient tactile disturbances (pruritus, pins and
needles, burning, numbness)
● Transient auditory and visual hallucinations
Usually resolves after 48 hours
24 - 48 hours ● Tachycardia
● Hypertension
● Marked agitation
● Withdrawal seizures
48 - 72 hours* ● Delirium tremens (disorientation, confusion,
severe anxiety)
● Seizures
● Hallucinations (typically visual)
● Profuse diaphoresis
● Tachycardia
● Tremors (severe)
Can present as early as 2 hours from cessation;
typically symptoms peak between 3-5 days
