Alcohol use disorders

Question 1

how are units calculated?

Answer 1

(%xVol)/10

Question 2

define the following:
-higher risk drinking
Inc risk drinking
low risk

Answer 2

• regularly consuming over 35 units per week
• consuming between 15-35 units wk
• should not be drinking more than 14 units a week

Question 3

When does alcohol use become harmful?

Answer 3

A pattern of psychoactive substance use that is causing damage to health, physical or mental

Question 4

Alcohol dependence syndrome- give the 6 criteria to be met?

Answer 4

strong desire/compulsion to drink
difficulty in controlling use of substance in terms of onset, termination or level of use
Physiological with drawl state
evidence of tolerance
progressive neglect of other pleasures
persistence of use despite clear evidence of harmful consequences

Question 5

What tool is used to asses?

what are the components?

Answer 5

CAGE

• Cutdown: do you ever feel like you want to cut down on your drinking?
• Annoyed: have people annoyed you be criticising your drinking?
• Guilty: have you ever felt bad or guilty about your drinking?
• Eye opener: have you ever had a drink first thing in the morning to steady nerves?

Question 6

What framework is used in an intervention?

Answer 6

FRAMES
Feedback - review problems experienced because of alcohol.
Responsibility – patient is responsible for change.
Advice – advise reduction or abstinence.
Menu – provide options for changing behaviour.
Empathy – use empathic approach.
Self-efficacy –encourage optimism about changing behaviour.

Question 7

What specialist interventions can be carried out?

Answer 7

Detoxification
(become alcohol free)

Release prevention 
(combination of psychosocial and pharmacological interventions aimed at maintaining abstinence )

Question 8

Alcohol withdrawal

• why does it occur?
• features of alcohol withdrawal syndrome? (11)
• how long does it last?

Answer 8

-alcohol inhibits the action of excitatory glutamate ion channels and chronic use leads to up regulation
alcohol potentiates actions of GABA so get down regulation of receptors
withdrawal causes excess glutamate activity and reduced GABA activity
excess glutamate activity is toxic to nerve cells and so get CNS excitability and neurotoxicity

-peak 24-48 hrs
Restlessness, tremor, sweating, anxiety, N+V, loss of appetite, insomnia 
tachycardia + systolic hypertension 
seizures 
Delirium tremens 

-5-7 days

Question 9

What is Delirium tremens

?

Answer 9

presents with night time confusion

confusion, disorientation, agitation, hypertension, fever, hallucinations, paranoid ideation

Question 10

Management?

• general?
• pharmacological?
• supplements?
• additional measures?

Answer 10

-reassurance

-baenzodiazepines
use long acting, diazepam, chlordiazepoxide
titrate against symptoms and reduce gradually over 7 days

• thiamine as prophylaxis against wernicke’s encephalopathy
• hydration, analgesia, antiemetics,

Detoxify at home unless high risk

Question 11

Relapse prevention

give 5 psychosocial interventions

Answer 11

Cognitive Behavioural Therapy (coping skills therapy)
Motivational Enhancement Therapy
12 Step Facilitation Therapy (eg AA)
Behavioural self control training.
Family and Couple Therapy

Question 12

• pharmacological prevention? (3)

- action of each?

Answer 12

-Disulfiram
inhibits acetaldehyde dehydrogenase leasing to accumulation of acetaldehyde if alcohol ingested
get flushing, tachycardia, arrhythmia, hypotension

Acamprosate
acts on glutamate and GABA systems
reduces cravings
SE: headache diarrhoea, nausea

Naltrexone
first line
opioid antagonist and reduces reward