Alcohol Use Disorder Flashcards
How much is one unit of alcohol?
10mls
What is the weekly limit of alcohol recommended for men and women?
14 units per week
How many people drink at hazardous or harmful levels?
20% of adult population
What is the definition of hazardous drinking?
Pattern of alcohol consumption that increases risk of harmful consequences for the user
Drinking more than 14 units a week but under 35 for women and 50 for men
What is the definition of harmful drinking?
A pattern of alcohol consumption that is causing mental or physical damage
Drinking more than 35 units for women and 50 for men
Describe alcohol dependence
Cluster of behaviour, cognitive and physiological factors that typically include strong desire to drink alcohol and difficulties controlling its use
What does alcohol use disorder include?
Alcohol abuse and alcohol dependence
Mild, moderate and severe
What is the DSM5 definition for alcohol use disorder (AUD)?
Maladaptive pattern of substance use leading to clinically significant impairment or distress
Manifested by 2 or more of criteria occurring any time over 12 months
What is the DSM5 criteria for AUD?
Impaired control - persistent desire, urge and takes more than intended
Social impairment - failure to work, school or role at home
Risky use - alcohol consumption in situations which are hazardous
Pharmacological criteria
What is the pharmacological criteria for AUD?
Tolerance - need for marked increased amounts to achieve intoxication or marked diminished effect with continued use
Withdrawal - withdrawal symptoms or alcohol taken to relieve these symptoms
What makes AUD mild, moderate or severe?
Mild - presence of 2-3 symptoms
Moderate - 4-5
Severe - 6 or more
Describe the alcohol use disorders identification test (AUDIT)
Comprehensive 10 question alcohol harm screening tool
Score 1 - 4
What score does the AUDIT give?
0-7 - lower risk
8-14 - hazardous drinking
15-19 - harmful drinking
20+ - possible dependence
What does the severity of alcohol dependence questionnaire measure?
Physical withdrawal
Affective withdrawal
Withdrawal relief drinking
Alcohol consumption
Rapidity of reinstatement
Describe the clinical institute withdrawal assessment for alcohol (CIWA-AR)
Ten item scale used in assessment and management of alcohol withdrawal
Describe motivational enhancement therapy
Express empathy by using reflective listening to convey understanding
Support self efficacy by building confidence
Learn deeply held values and current behaviour
What is the pharmacological treatment for AUD?
Chlordiazepine drug of choice
What are the problems of pharmacological treatment of AUD?
High rate of relapse
Cognitive impairment
Kindling effect - severity of withdrawal symptoms tends to increase after each withdrawal
What are the symptoms of alcohol withdrawal syndrome?
Tremor, sweating, nausea, retching, increased HR, BP, temp., anxiety, insomnia, agitation, hallucinations, withdrawal seizures and delirium tremens
What is the symptoms of delirium tremens?
48-72 hours after
Coarse tremor, confusion, delusion and hallucinations
What is included in complicated withdrawal?
Seizures, hallucination, delirium tremens and Wernicke encephalopathy
What are psychological interventions for relapse prevention?
CBT, motivational enhancement therapy, 12 step facilitation therapy and family + couple therapy
What are some relapse prevention medications?
Acamprosate, naltrexone and disulfiram
Describe Acamprosate
Action on GABA and glutamate transmission, correct neurotransmission imbalance post withdrawal and reduces cravings
Well tolerated and no need for blood test
Describe Naltrexone
Blocks opioid receptors
Reduce rewarding effect mediated by endorphin system
Describe Disulfiram
Psychological deterrent
Anti craving effect through increased dopamine transmission
Dangerous reaction when mixed with alcohol
What are the potential side effects of disulfiram?
Hepatotoxicity, neuropathy and psychosis
Describe baclofen
GABA b agonist
Reduces craving
Risk of abuse and severe side effects
