Alcohol Use Disorders Flashcards
What are the genetic factors in AUD?
- 40-60% genetic influence
- heterogeneous contribution
- gene studies: chromosome 4 offers protection, chromosome 1 and 7 contributes to vulnerability.
What are the four environmental factors that contribute to AUD?
- political and economic factors
- socio-cultural factors eg rites of passage
- occupation eg hospitality industry, FIFO workers; time away from home increases ETOH
- family experience of heavy drinking eg raised in a pub
What is the relationship between stress and alcohol?
- increased frequency of stressful life events precedes alcohol use
- alcohol relieves anxiety by acting on dopamine. Anxiety precedes alcohol, depression follows
- if person is stress-reactive then more sensitive to stress and alcohol
How do you calculate the content of alcohol?
mL x %strength x .79gm of ethanol / 10
1mL ethanol = .79gm of pure ethanol
10 gms alcohol = 1 std drink
What are the 3 milestones/phases of drinking?
- Evolution of drinking
- Evolution of drinking problems
- Evolution of dependence
What are the 6 effective CBT treatments?
No single category but several methods: - Behavioural self-control - Behavioural contracting - Social skills training - Cue exposure - Behavioural marital therapy - Relapse prevention MI
Describe characteristics of 5 intervention goals and give examples.
- Negotiated
- Specific, observable
- ST targets
- Achievable
- Priorities
E.g. Change how fast alcohol taken, drink water/coke every second drink, reduce frequency, dose or mix of alcohol (light beers), reducing alcohol related behaviours, abstinence
What are the components of self-management plans?
- remove self from triggers
- manage environment
- use different behaviour in same envt
- set limits to use
- strategies to keep limits
- manage cognition about drinking
- manage emotions
- drink refusal skills
- dealing with urges
What are 6 strategies for setting limits?
- realistic and concrete eg 2 per day
- if bingeing, set maximum daily limit
- if binge then have next two days alcohol free
- 2 alcohol free days per week
- taper each week to 0
- follow national guidelines
What are some strategies for keeping to limits?
- Plan ahead
- count drinks
- slow down (no gulping, put glass down, don’t refill)
- alternate with non-alcoholic, dilute drinks
- drink lower alcohol content, smaller drinks
- don’t drink to quench thirst
- eat before drinking, no salty nibbles
- don’t ‘shout’ or have favourite drink
- drink refusal skills
What are the most widely used empirically-supported approaches in AUD treatment?
- Brief intervention
- MI
- CBT
Stepped care is recommended
What are the steps in functional analysis?
- Triggers: env’t, interpersonal, emotions, thoughts, physical sensations
- Thoughts/feelings/images: eg I need a drink
- Drink: Did one lead to another? Was this intentional
- Positive consequences (usually immediate)
- Negative consequences (later)
What do you teach clients about cognitions and drinking?
- the connection between situations, thoughts, feelings, behaviour, drinking
- use thought monitoring to clarify
- focus on: cognitive distortions (coping with stress) and temptation coping
What are four targets for addressing problematic alcohol-related cognitions?
- Cognitive distortions and schemas (perfectionism, things have to go the way I want them to)
- Thoughts/images about alcohol/things associated with alcohol create urges
- Thoughts about positive effects ‘One won’t hurt’
- Negative thinking eg self-talk
Teach them stop, think, re-think
How can you teach clients to cope with thoughts/images about drinking?
Stop, think, rethink
Review pros and cons:
- positive and negative consequences
- recall core values of why you want to stop
- refocus on positive consequences of not drinking
How do pple become more sensitive to alcohol (incentive sensitisation)?
Casual or intermittent drug use sensitises the mesolimbic reward system. This increases the attractiveness of the drug and people want it more.
Stress drives gluticocorticoids (stress-related hormones) which alter dopamine signalling, increasing the positive reinforcing effects of alcohol. The temporal connection heightens effect due to dopamine processing.
What are the psychological factors that influence dependence?
- dopamine release acts as positive reinforcer
- anticipation of reward/pleasure
- negative reinforcement: avoid the feeling of not having alcohol
- negative reinforcement: anxiety reduction
How does stress disrupt homeostasis?
- Excessive/prolonged stress leads to dysregulsted homeostasis, leading to reward dysfunction
- decrease in dopamine which recruits Corticotropin-releasing factor leading to negative affect (anxiety, dysphoria, craving)
- Further drug use is negatively reinforced (ie drink more to compensate). Person can present as depressed.
What are the principles of relapse prevention?
- reframe lapse as a tumble, not a fall
- teach the abstinence violation effect
- reframe as opportunity to learn new triggers etc
- stop, think, change course
- delay further drinking by stopping drinking and doing something else
- identify high risk situations, rate difficulty, identify early warning signs, plan for these
- educate re: seemingly irrelevant decisions
What are the principles of stress and temptation coping skills?
Decisions - plan ahead Detour - initially avoid high risk situations Distract from use - positive activity Delay (stop, challenge, alternative) De-stress - CBT strategies
What do you assess when assessing the evolution of drinking?
Firsts: - drinking - drinking most weekends - spirits - drinking every day - amounts over time When did current pattern start? Periods of abstinence and why
What do you ask about when assessing the evolution of drink-related problems?
Impact on health and social functioning
- ‘When did you first realise drinking was a problem?’
- ‘Looking back, when do you think it really became a problem?’
What is dependence?
When client couldn’t control or got hooked
Neuroadaptation: increasing dependence on alcohol reflecting tolerance and withdrawal
