Alcohol use disorders Flashcards
What is the recommended maximum consumption of alcohol weekly?
14 units for men and women
Spread evenly over 3+ days
Avoid any alcohol in pregnancy
How many units are consumed in a binge?
Over what time period?
5-7 units in 3-6 hours
How much is one unit of alcohol?
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)
How is ethanol metabolised?
Define act-risk use
Substance use where the person is at increased risk of harming their physical or mental health
What are alcohol use disorders?
- Harmful drinking
- Alcohol dependence
Define harmful drinking
Pattern of alcohol consumption causing health problems (biological; psychological or social) directly related to alcohol
What is alcohol dependence?
Alcohol dependence is characterised by:
- Craving
- Tolerance
- Preoccupation with alcohol
- Continued drinking in spite of harmful consequences
Outline the diagnostic criteria of dependence syndrome
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
How is the presence of an alcohol use disorder defined by the DSM-5?
‘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+)
List three risk factors for alcohol dependence
- Men (3:1)
- FHx: 1o relatives
- Lower socioeconomic groups
- Younger
- Certain professions: eg. Industry, sales, doctors, army
List five complications of alcohol misuse
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
What are the symptoms of acute intoxication from alcohol?
Initial: Elevated mood, disinhibition, impaired judgement
Later:
- Slurred speech, unsteady gait, nystagmus, ataxia
- Aggression, labile mood
- Impaired consciousness
Severe: Stupor; coma
Outline the screening of alcohol use disorders
AUDIT (alcohol use disorders identification test)
AUDIT-C is a faster screen using the first three Qs
Request two investigations for suspected alcohol misuse
- 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
Outline the managment of alcohol misuse in primary care
Admit if acute withdrawal; risk of seizures/DT; Wernicke’s
Offer specialist alcohol services if moderate/severe dependence
- Brief advice to help realise the impact of alcohol
- Psychological intervention eg. CBT; behavioural therapy
- Referral to specialist alcohol treatment services
Consider prophylactic oral thiamine
Give two indications for prescribing a reducing detox regime
- Clinical symptoms of withdrawal
- History of alcohol dependence syndrome
- Consumption of 10+ units/day over past 10/7
Outline maintenance interventions for alcohol misuse
- Bio: Disulfiram, Acamprosate, Naltrexone
- Psycho: Individual counselling
- Social: Alcoholics Anonymous
What driving advice must be given to patients with persistent alcohol misuse?
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
What driving advice must be give to patients with alcohol dependence?
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
What is the driving advice in relation to Alcohol-related seizures?
Must not drive and must notify the DVLA
- Surrender licence for 6/12 (5y if bus/lorry)
