Alcohol Use Disorders Flashcards
What are some high risk occupations in alcohol use disorders?
Bartenders
Itinerant Workers
Professional autonomy eg doctors
What is higher risk drinking?
Regularly consuming >35 units per week
What is increased risk drinking?
Regularly consuming 15-35 units per week
What is harmful use of alcohol?
A pattern of psychoactive substance use that is causing damage to health. The damage may be physical (as in cases of hepatitis from the self-administration of injected psychoactive substances) or mental (e.g. episodes of depressive disorder secondary to heavy consumption of alcohol)
What are the features of alcohol dependence syndrome?
Strong desire or sense of compulsion to take drug
Difficulty in controlling use of substance in terms of onset, termination or level of use
Physiological withdrawal state
Evidence of tolerance
Progressive neglect of other pleasures /interests because of use /effects of substance
Persistence with use despite clear evidence of harmful consequences
What is GGT an indicator of in alcohol use disorders?
Liver injury
What does Carbohydrate Deficient Transferin identify?
Men drinking 5 or more units per day for a year or more
What is the most common cause of raised MCV?
Alcoholism
What are brief interventions in alcohol use disorders?
For adults who have been identified via screening
Attend NHS/NHS-commissioned services or services offered by other public institutes
5-15 mins
What is the FRAMES tool in interventions?
Feedback Responsibility Advice Menu Empathy Self-efficacy
When should referral for specialist treatment be considered in alcohol use disorders?
Show signs of moderate or severe alcohol dependence
Have failed to benefit from structured brief advice and an extended intervention and wish to receive further help for an alcohol problem
Show signs of severe alcohol-related impairment or have a related co-morbid condition.
What is relapse prevention?
A combination of psychosocial and pharmacological interventions aimed at maintaining abstinence or problem free drinking following detoxification
What does alcohol inhibit?
The action of excitatory NMDA-glutamate controlled ion channels (chronic use leads to upregulation of receptors)
What does alcohol potentiate?
The actions of inhibitory GABA type A controlled ion channels (chronic use leads to downregulation of receptors)
What does alcohol withdrawal lead to neurologically?
Excess glutamate activity and reduced GABA activity
Excess glutamate activity is toxic to nerve cell
Acute withdrawal leads to CNS excitability and neurotoxicity
Describe the Alcohol Withdrawal Syndrome
Not a uniform entity
First symptoms occur within hours and peak at 24-48 hours.
Restlessness, tremor, sweating, anxiety, n+v, loss of appetite and insomnia.
Tachycardia and systolic hypertension evident.
Generalised seizures and Delirium Tremens can occur – usually in first 24 hours.
In most, symptoms resolve in 5-7 days.
When does delirium tremens present?
Peak onset within 2 days of abstinence
What does delirium tremens often present insidiously with?
Night time confusion
What are the features of delirium tremens?
Confusion Disorientation Agitation HT Fever Visual and auditory hallucinations Paranoid ideation
What is the mortality of delirium tremens?
2-5% (associated with cardiovascular collapse and infection)
What is involved in the management of alcohol withdrawal?
General Support
Benzos
Vitamin supplementation
What is important in benzo treatment in alcohol withdrawal?
Cross tolerant with alcohol (act on GABA A receptiors)
Use long acting agents eg. Diazepam, chlordiazepoxide
Titrate against severity of withdrawal symptoms
Reduce gradually over 7 days or more.
Be guided by withdrawal rating scales eg CIWA-Ar
What is important in vitamin supplementation in alcohol withdrawal treatment?
Thiamine as prophylaxis against Wernickes Encephalopathy
Must be parenteral
Increase dose if Wernickes suspected
What additional measures can be used in alcohol withdrawal management?
Adequate hydration Analgesia Antiemetics Treat intercurrent infections and other physical conditions Environmental factors
Where should the majority of patient be detoxified?
The community
When should patients be detoxified in hospital?
Severe dependence
A history of Delirium Tremens or alcohol withdrawal seizures (current DT requires transfer to gen med ward)
A history of failed community detoxifications
Poor social support
Cognitive impairment
Psychiatric co-morbidity
Poor physical health
How should relapse prevention be conducted?
CBT Motivational Enhancement Therapy 12 Step Facilitation Therapy Behavioural self control therapy Family/couple therapy
Is there a place for benzos beyond detoxification period?
No
What does Disulfiram do?
Inhibits acetaldehyde dehydrogenase leading to accumulation of acetaldehyde if alcohol is ingested.
Leads to flushed skin, tachycardia, n+v, arrhythmias and hypotension depending on volume consumed.
Efficacy requires compliance.
What does Acamprosate do?
Acts centrally on glutamate and GABA Systems
Reduces cravings with a modest treatment effect
When should Acamprosate be started?
As soon as detox is complete, and continue through relapses
What are some S/Es of Acamprosate?
Headache
Diarrhoea
Nausea
Describe Naltrexone
First line agent for relapse prevention
Opioid antagonist and reduces reward from alcohol
