Alcohol use disorder Flashcards
Define substance use disorder
Substance use disorder is defined as a
cluster of cognitive, behavioural, and
psychological symptoms indicating that
the individual continues using despite
significant substance-related problems
Tolerance
The need for a larger dose of a drug to obtain the original effects
Relief craving
The intense desire for a
substance, usually experienced after decreased use
Reward craving
Occurs in the presence of
people, places, or things associated with
substance taking
Relapse
Returning to substance use after a
period of abstinence
Urgent care regarding alcohol use
Intoxication responses usually last less than 24 hours and are directly related
to the ingestion of alcohol
Overdose priority
First priority of care is ABCs (airway, breathing, and circulation)
____ % of the population
aged 15 years and older drink alcohol
78 (most widely consumed substance)
Indigenous people and alcohol
experience increased
harm related to alcohol use
Interrelated dependence factors (genetic,
psychosocial, cultural–environmental)
BAC
Concentration can be determined by
assessing the blood alcohol concentration
BAC is affected by the amount consumed,
drinking rate, drink concentration, body
size and composition, and hormones.
Alcohol primarily affects the
central nervous system (CNS)
Screening using the CAGE questions
C (cut-down) - Have you felt you ought to
cut down on your drinking/drug use?
A (annoyed) - Have people annoyed you
by criticizing your drinking/ drug use?
G (guilt) - Have you felt bad or guilty
about your drinking/drug use?
E (eye opener) - Have you ever had a
drink or used drugs first thing in the
morning to steady your nerves or get rid
of a hangover or to get the day started?
Alcohol withdrawal length (start to end)
Most alcohol-dependent patients
experience a minor withdrawal syndrome
in the first 6–12 hours after the last drink.
May last 3–5 days
Symptoms of Alcohol withdrawal
Tremulousness
Anxiety
Heart rate
Blood pressure
Sweating
Nausea
Hyperreflexia
Agitation
Insomnia
Hallucinations
Severe signs of withdrawal
Hallucinations, Seizures and delirium tremens.
Delirium Tremens
Anticipated within 48- 72 hours of alcohol withdrawal (last drink)
Severity depends on how much alcohol was ingested and for how long
Symptoms:
Anxiety, uncontrollable fear
Tremor
Irritability
Agitation
Insomnia
Visual, auditory, tactile, olfactory hallucinations
Autonomic over-activity- dilated pupils, profuse perspiration, elevated Vital
signs
DTs is a life threatening condition, with high mortality rate
Death may be caused by hyperthermia, peripheral vascular collapse, or cardiac
failure.
Complications of Chronic
Alcohol Abuse
Wernicke’s encephalopathy, Korsakoff syndrome, nutritional deficiencies, HF, Hypertension
Wernicke’s encephalopathy
a life-threatening condition caused by chronic thiamine deficiency
affects CNS and PNS
Nystagmus, ataxia, confusion
Korsakoff syndrome
Condition that results from chronic thiamine deficiency
Damage to nerve cells in the brain and spinal cord
Memory issues
Diagnostic labs re Nutritional
Deficiencies/other medical
problems
CBC
chemistry with pre-albumin
lipid profile
Thiamine
Folate (folic acid)
B12
Iron, magnesium levels
Hepatitis screen
Urinalysis
Ethanol (Blood Alcohol, Blood
ET0H) level (critical values)
Critical Level > 64.8 mmol/L OR >
300 mg/dL
Interprofessional
Care of a Patient
with Alcohol Use
Disorder
Initial treatment is
withdrawal management.
Supportive measures to
promote ventilation and
circulation until alcohol is
metabolized
Medications to decrease
symptoms, increase level
of comfort, and decrease
risk of seizures and DTs
disulfiram, acamprosate
Disulfiram (Antibuse)
: Aversive therapy causing severe
reactions if alcohol is consumed ( even up to 14 days
after last drink ; small amounts of alcohol- mouthwash,
aftershave, cough medicine can cause a reaction
Reactions- flushing, seating, headache, neck pain,
palpitations, dyspnea, tachycardia, hypotension, confusion,
CONVULSIONS, DEATH- activate EMS; may give Benadryl to
treat reaction
Acamprostate (Campral)
after detox of 7 days and opiate
free 10 days; recommended for 1 year- used in US
Side effects- GI upset, myalgia, headache, rash, syncope,
palpitations, edema, Impotence
Special considerations for Perioperative care
If delirium tremors occurs in the post-operative phase
significant mortality rate is associated with cardiac
dysrhythmias, cardiomyopathy, and bleeding tendencies
seen in long–term alcohol abuse
Screen ALL patients for alcohol use
Some patients may deny alcohol use - suspect alcohol
withdrawal in patients who develop symptoms (tremors,
diaphoresis, anxiety etc.) after a period of
hospitalization
6-12 hours after alcohol withdrawal
Minor withdrawal symptoms: insomnia, tremors, anxiety, gastro-intestinal upset, headache, diaphoresis, palpitations, anorexia, nausea, tachycardia, hypertension
12–14 hours after alcohol withdrawal
Visual, auditory, or tactile hallucinations
24–48 hours after alcohol withdrawal
Withdrawal seizures: generalized tonic–clonic seizures
48–72 hours after alcohol withdrawal
Alcohol-withdrawal delirium (delirium tremens): hallucinations (predominantly visual), disorientation, agitation, diaphoresis
Example of a screening tool with withdrawal severity
Clinical Institute Withdrawal Assessment for Alcohol (CIWA)
Mild withdrawal symptoms
Anxiety, tremors (shaking), insomnia, headache, nausea, and irritability. Typically lasts 24-48 hours
Moderate Alcohol Withdrawal:
In addition to mild symptoms, moderate withdrawal may involve increased heart rate, elevated blood pressure, sweating, and confusion. It lasts 48-72hours
Severe Alcohol Withdrawal
Severe symptoms may include hallucinations, severe confusion, seizures, fever, and agitation. Delirium tremens (DT) lasts 48-72 hours but DT can last for up to a week
