Alcohol Use Disorder Flashcards
how much is one unit of alcohol
10mls/8grams
how many units= binge drinking
more than 8 units in one day
how many people admitted to hospital are at risk of alcohol withdrawal
8%
how many units per week is advised
max 14
how many people drink to a hazardous level
1 in 4 (more than 14 units)
define hazardous drinking
a pattern of alcohol consumption that increases risk of harmful consequences for the user
drinking more than 14 but less than 35 (women)/ 50 (men) units per week
define harmful drinking
a pattern of alcohol consumption that is causing mental or physical drinking
drinking 35/+ a week (women) or 50/+ (men) units a week
define alcohol dependence
a cluster of behaviour, cognitive and physiological factors that typically include a strong desire to drink alcohol and difficulties in controlling its use
what are the severities of alcohol use disorder
mild 2-3 symptoms
moderate 4-5 symptoms
severe 6+ symptoms
what is the criteria for alcohol use disorder
DMS 5
a maladaptive pattern of behaviour of substance use leading to clinically significant impairment or distress- as manifested by 2+ of (occurring at same time within 12 month period):
Alcohol is often taken in larger amounts or over a longer period than was intended.
There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
Craving, or a strong desire or urge to use alcohol.
Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
Recurrent alcohol use in situations in which it is physically hazardous.
Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
define tolerance
either:
a need for markedly increased amounts of alcohol to achieve intoxication or desires effect
or
a markedly diminishes effect with continued use of the same amount of alcohol
what are the two ways withdrawal can manifest
characteristic withdrawal syndrome
alcohol/ closely related substance (benzodiazepine) is taken to relieve of avoid withdrawal symptoms
name the comprehensive 10 question alcohol harm screening tool
alcohol use disorder identification test AUDIT
what does the severity of alcohol dependence questionnaire measure
physical withdrawal affective withdrawal withdrawal relief drinking alcohol consumption rapidity of reinstatement
what is the ‘clinical institute withdrawal assessment for alcohol’ (CIWA-AR)
ten item scale used in the assessment and management of alcohol withdrawal
what do AUDIT score mean
0-7= lower risk drinking, reinforce current drinking problems
8-14= hazardous drinking, deliver brief intervention
15-19= harmful drinking, deliver brief intervention and motivational enhancement therapy session, consider prescribing options
20+/ DUI 15+ = possible dependence, do comprehensive assessment
what are the components of the brief intervention
FRAMES
feedback (review problems)
responsibility (patient responsible for change)
advice (advise reduction or abstinence)
menu (provide option for changing behaviour)
empathy
self -efficacy (encourage optimism about changing behaviour)
what are the four principles of motivational enhancement therapy
express empathy 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 than confrontation
support self efficacy by building confidence that change is possible
what are the psychological interventions for relapse prevention
cognitive behavioural therapy
motivational enhancement therapy
12 step facilitation therapy (AA)
family and couple therapy
what drugs are used for medically assisted detoxification
chlordiazepoxide
what are the problems with chlordiazepoxide
high rate of relapse after successful medicated withdrawal
cognitive impairment, cumulative neuronal damage
kindling effect (severity of withdrawal symptoms tends to increase after each alcohol withdrawal
what are the symptoms of alcohol withdrawal
tremor, sweating, nausea, retching
increased HR, BP and temp
anxiety, agitation
insomnia, nightmares
auditory, visual, tactile hallucinations
withdrawal seizures (0-48 hrs)
delirium tremens (48-72 hrs): coarse tremor, confusion, delusions, hallucinations
what causes alcohol withdrawal syndrome
high glutamate, low GABA
what are the features of a complicated alcohol withdrawal
seizures
hallucinations
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 cravings
how does naltrexone work
blocks opioid receptors
reduces rewarding effect mediated by endorphin system
what are endorphins
endogenous opioid neuropeptides
how does disulfiram work
causes and unpleasant and dangerous reaction when alcohol consumed
psychological deterrent
anticraving effect through increased dopamine transmission
potential rare but severe SEs
low compliance
how do you calculate units
volume x percentage
what mental problem can steroid cause
mania
what can abscesses in IVDU lead to
aneuysm in femoral arteries, osteomyelitis, septic arthritis, infective endocarditis
