Alcohol Use Disorders Flashcards
Highest rates of alcohol consumption are in which individuals?
Highest rate is in adolescence and early 20s
High risk occupations inc. bartenders, itinerant workers, professional autonomy, e.g: doctors
What is a unit of alcohol?
1 unti = 10ml alcohol
No. of units = (% x volume) / 10
Levels of risk in drinking?
Higher risk drinking - regularly consuming >35 units per week
Increased risk drinking - regularly consuming between 15-35 units per week
Low risk drinking (UK guidelines) - men and women should not regularly drink >14 units of alcohol a week; ideally, this should be spread evenly over 3 days or more
NOTE - their is no such thing as drinking with no risk
Definition of harmful use of alcohol?
A pattern of psychoactive substance use that is causing damage to health
Damage may be:
• Physical, e.g: hepatitis due to self-administration of injected psychoactive substances
• Mental, e.g: episodes of depressive disorder secondary to heavy consumption of alcohol
Examples of physical consequences of alcohol use disorder?
N&V, gastritic, peptic ulcers, diarrhoea, Mallory-Weiss tears, oesophageal varices, malnutrition, GI haemorrhage
Thiamine deficiency, vitamin C deficiency, folate deficiency, iron deficient anaemia
Hepatitis, cirrhosis
Hypertension, cardiac arrhythmias, cardiomyopathy, haemorrhagic and thrombotic CVA
Gonadal atrophy, infertility, gynaecomastia, erectile impotence, anorgasmia, miscarriage, recurrent abortion
Pseudo-Cushing’s
Cancer (oropharyngeal, oesophageal, colorectal, pancreatic, hepatic, lung)
ETC
Criteria for alcohol dependence syndrome?
Strong desire to take drug (cravings)
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, e.g: children, family, etc
Persistence with use despite clear evidence of harmful consequences
Tools available to check for alcohol use disorders?
AUDIT (Alcohol User Disorders Identification Test) - 10 Qs that aim to detect hazardous drinking
CAGE - 4 Qs that aim to detect alcohol abuse and dependence: • Cut-down • Annoyed • Guilty • Eye-opener
T-ACE: • Tolerance • Annoyed • Cut-down • Eye-opener
TWEAK - screens for alcohol problems in pregnant women: • Tolerance • Worried • Eye-opener • Kut down
MAST (Michigan Alcohol Screening Test) - full version used in psychiatric settings
FAST (Fast Alcohol Screening Test) - suitable for A&E as it contains only 4 items; if the patient is +ve with FAST, use AUDIT (which has 10 items, 4 of which are from FAST)
PAT (Paddington Alcohol Test) - also suitable for A&E testing
Role of lab testing for alcohol?
Not useful when screening for alcohol-related problems but may have a role in monitoring response to treatment
Main blood tests for alcohol?
GGT (indicator of liver injury)
Carbohydrate Deficient Transferin - identifies men drinking 5 or more units per day for 2 weeks or more
Mean Corpuscular Volume (MCV) - alcoholism is the most common cause of a raised MCV
NOTE - none of these tests are specific
Duration of brief intervention for alcohol?
5-15 minutes
Target patients for brief interventions?
Adults who, via screening, have been identified as drinking hazardous or harmful amounts of alcohol
Patients attending NHS services or other public institutes
FRAMES for dealing with patients with alcohol use disorders?
Feedback - review problems experience due to alcohol
Responsibility - patient is responsible for change
Advice - advise reduction or abstinence
Menu - provide options for behaviour change
Empathy - use an empathic approach
Self-efficacy - encourage optimism about changing behaviour
When should referral for specialist treatment be considered?
If the patient:
• Shows signs of moderate or severe alcohol dependence
• Has 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
Types of specialist intervention?
Detoxification - process by which patients become alcohol-free
Relapse prevention - a combo of psychosocial and pharmacological interventions aimed at maintaining abstinence or problem-free drinking following detoxification
Mechanism of alcohol withdrawal?
Alcohol inhibits excitatory NMDA-glutamate controlled ion channels (chronic use leads to up-regulation of receptors)
Alcohol potentiates inhibitor GABA type A controlled ion channels (chronic use leads to down-regulation of receptors)
So, alcohol withdrawal leads to excess glutamate activity (sudden glutamate flood binding to up-regulated glutamate receptors)
There is also reduced GABA activity during withdrawal (GABA drops and receptors are down-regulated)
So, acute withdrawal of alcohol in those with dependence is a neurotoxic process and leads to CNS excitability and neurotoxicity
