Alcohol use disorders

Question 1

What is the recommended maximum consumption of alcohol weekly?

Answer 1

14 units for men and women

Spread evenly over 3+ days

Avoid any alcohol in pregnancy

Question 2

How many units are consumed in a binge?

Over what time period?

Answer 2

5-7 units in 3-6 hours

Question 3

How much is one unit of alcohol?

Answer 3

10ml (8g) of pure ethanol

Units = total volume (L) x %ABV

One unit is roughly equivalent to:

• ¹/₂ pint of beer, lager, or cider (3% ABV)
• 25ml of spirits (40% ABV)
• 50ml of fortified wine (20% ABV)

Question 4

How is ethanol metabolised?

Answer 4

Question 5

Define act-risk use

Answer 5

Substance use where the person is at increased risk of harming their physical or mental health

Question 6

What are alcohol use disorders?

Answer 6

• Harmful drinking
• Alcohol dependence

Question 7

Define harmful drinking

Answer 7

Pattern of alcohol consumption causing health problems (biological; psychological or social) directly related to alcohol

Question 8

What is alcohol dependence?

Answer 8

Alcohol dependence is characterised by:

• Craving
• Tolerance
• Preoccupation with alcohol
• Continued drinking in spite of harmful consequences

Question 9

Outline the diagnostic criteria of dependence syndrome

Answer 9

At least 3 symptoms over a 12-month period:

• Strong desire or compulsion to take substance
• Impaired control over use
• Withdrawal symptoms or relief use
• Tolerance
• Salience: prioritisation of drug above all else
• Persistent use despite clear evidence of harm
• Rapid reinstatement after abstinence

Question 10

How is the presence of an alcohol use disorder defined by the DSM-5?

Answer 10

‘Yes’ to 2+ of the following, within the past year:

• Compulsion
  
  • >once wanted/tried to cut down or stop, but couldn’t
  • Wanting to drink that couldn’t think of anything else
• Impaired control
  
  • Ended up drinking more/longer than intended
• Persistant use despite harm
  
  • Lots of time drinking, sick, or getting over its effects
  • Drinking interfered with social ^eg. family; work; school
  • Continued to drink even when causing social trouble
  • >once gotten into situations at increased risk of harm
  • Continued to drink despite causing depression/anxiety
• Salience: prioritise drinking over other activities
• Tolerance
• Withdrawal including psychosis

Mild (2-3); Moderate (4-5); Severe (6+)

Question 11

List three risk factors for alcohol dependence

Answer 11

• Men (3:1)
• FHx: 1^o relatives
• Lower socioeconomic groups
• Younger
• Certain professions: ^eg. Industry, sales, doctors, army

Question 12

List five complications of alcohol misuse

Answer 12

Short term:

• Death and illness from accident and injury; drowning
• Poisoning; self-harm

Long term:

• Cancer: ^eg. mouth; throat; bowel; stomach; liver; breast
• Alcoholic cardiomyopathy; arrhythmias; HTN
• Alcoholic liver disease; chronic pancreatitis
• Psychiatric illness
• Wernicke’s enchalopathy; Korsakoff’s psychosis
• Fetal alcohol syndrome
• Social complications

Question 13

What are the symptoms of acute intoxication from alcohol?

Answer 13

Initial: Elevated mood, disinhibition, impaired judgement

Later:

• Slurred speech, unsteady gait, nystagmus, ataxia
• Aggression, labile mood
• Impaired consciousness

Severe: Stupor; coma

Question 14

Outline the screening of alcohol use disorders

Answer 14

AUDIT (alcohol use disorders identification test)

AUDIT-C is a faster screen using the first three Qs

Question 15

Request two investigations for suspected alcohol misuse

Answer 15

• Breathalyser: recent drinking (e.g. supervised detox)
• Blood tests to monitor patients at follow-up
  
  • FBC: macrocytic anaemia for 2-3/12
  • Elevated GGT for 2-3/52
  • Elevated %CDT for 2-3/52 after heavy drinking

Question 16

Outline the managment of alcohol misuse in primary care

Answer 16

Admit if acute withdrawal; risk of seizures/DT; Wernicke’s

Offer specialist alcohol services if moderate/severe dependence

1. Brief advice to help realise the impact of alcohol
2. Psychological intervention ^eg. CBT; behavioural therapy
3. Referral to specialist alcohol treatment services

Consider prophylactic oral thiamine

Question 17

Give two indications for prescribing a reducing detox regime

Answer 17

• Clinical symptoms of withdrawal
• History of alcohol dependence syndrome
• Consumption of 10+ units/day over past 10/7

Question 18

Outline maintenance interventions for alcohol misuse

Answer 18

• Bio: Disulfiram, Acamprosate, Naltrexone
• Psycho: Individual counselling
• Social: Alcoholics Anonymous

Question 19

What driving advice must be given to patients with persistent alcohol misuse?

Answer 19

Must not drive and must notify the DVLA:

• If they refuse, doctor has responsibility to inform the DVLA
• Licence will be refused/revoked until both:
  
  • 6/12 (1y if bus/lorry) of controlled drinking/abstinence
  • Normalisation of blood parameters

Question 20

What driving advice must be give to patients with alcohol dependence?

Answer 20

Must not drive and must notify the DVLA

• Required to surrender their driving licence
• Until 1yr free of alcohol problems (3 yr if bus/lorry)
• Abstinence is usually required

Question 21

What is the driving advice in relation to Alcohol-related seizures?

Answer 21

Must not drive and must notify the DVLA

• Surrender licence for 6/12 (5y if bus/lorry)