Alcohol Use Disorders

Question 1

How much is 1 unit of alcohol?

Answer 1

10ml

Question 2

Epidemiology of alcohol use disorder

Answer 2

M:f::2:1
Female alcoholism is probably unreported
8% of all patients admitted hospital are at risk of alcohol withdrawal

Question 3

Definition of hazardous drinking

Answer 3

Pattern of alcohol consumption that increases the risk of harmful consequences for the user.

It is not a diagnostic term.

14units < W < 35units
14units < M < 50units

Question 4

Definition of harmful drinking

Answer 4

A pattern of alcohol consumption that is causing mental or physical damage

W>35units
M>50 units

Question 5

Definition of alcohol dependance

Answer 5

A cluster of behavioural, cognitive and physiological factors that typically include a strong desire to drink alcohol and difficulties in controlling its use

Question 6

DSM IV classification of alcohol use disorders

Answer 6

Two distinct disorders: alcohol abuse and alcohol dependence

Specific criteria for each

Question 7

DSM 5 classification of alcohol use disorders

Answer 7

Integrates alcohol abuse and alcohol dependence (DSM IV) into a single disorder called ‘alcohol use disorder’ (AUD).

Mild, moderate or severe

Question 8

DSM 5 criteria for alcohol use disorder (9)

Answer 8

2 or more of the following occuring any time in the same year:

Alcohol is consumed in larger amounts or over a longer period than was intended.

Persistent desire or unsuccessful efforts to cut down

A great deal of time is spent to obtain, use or recover from alcohol and its effect

Craving, or feeling compelled to drink

Failure to fulfil major role obligations at work, school, or home due to alcohol use

Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.

Important social, occupational, or recreational activities are given up or reduced because of alcohol use.

Recurrent alcohol use in situations in which it is physically hazardous.

Drinking despite harmful consequences

Question 9

What is tolerance (DSM5 criteria)?

Answer 9

A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.

A markedly diminished effect with continued use of the same amount of alcohol.

Question 10

What is withdrawal according to DSM 5 criteria?

Answer 10

The characteristic withdrawal syndrome for alcohol

Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

Question 11

Determining severity of alcohol use disorder

Answer 11

Mild - 2 to 3 symptoms
Moderate- 4 to 5 symptoms
Severe - 6+ symptoms

Question 12

List the screening tools for identifying AUD

Answer 12

1. CAGE
2. AUDIT
3. FAST
4. Severity of alcohol dependance questionnaire (SAD-Q)
5. Clinical Institute Withdrawal Assessment for Alcohol (CIWA-AR) - 10 item scale used in assessment and management

Question 13

Features of severity of alcohol dependance questionnaire

Answer 13

Physical withdrawal
Affective withdrawal
Withdrawal relief drinking
Alcohol consumption
Rapidity of reinstatement

Question 14

Intervention techniques

Answer 14

1. Brief intervention
2. Motivational enhancement therapy
3. Medical assisted detoxification (only if dependant)
4. Relapse prevention - psychosocial Intervention and pharmacological treatment

Question 15

Indications for brief intervention

Answer 15

Audit score between 8-20

Acronym ‘FRAMES’

Question 16

Features of brief intervention

Answer 16

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 17

Features of motivational enhancement therapy

Answer 17

Indicated in harmful drinking

Expression of empathy

• use reflective listening
• to sidestep resistance rather than confrontational approach

Support self efficacy

Question 18

Indication of medication assisted detoxification

Answer 18

If brief intervention and motivational enhancement therapy is not working

If patient has withdrawal syndrome

Question 19

What are commonly experienced withdrawal symptoms

Answer 19

Tremor, sweating, nausea, retching

Increased HR, BP, T

Anxiety, agitation

Insomnia, nightmares

Auditory, visual, tactile hallucinations

Withdrawal seizures (0-48 hours)

Delirium tremens (48-72 hours) coarse tremor, confusion, delusions, hallucinations

Question 20

Describe complicated withdrawal

Answer 20

Seizures
Hallucinosis
Delirium Tremens
Wernicke-Korsakoff Syndrome

Question 21

Drug used in medical assisted detoxification

Answer 21

Chlordiazepoxide

Question 22

SE of drug used in detoxification

Answer 22

High rate of relapse
Cognitive impairment, cumulative neuronal damage
Kindling effect - severity of withdrawal symptoms Increase after each alcohol withdrawal

Question 23

Drugs used in pharmacological prevention of relapse

Answer 23

Acamprosate
Naltrexone
Disulfiram

Question 24

MOA of Acamprosate

Answer 24

Action on GABA and Glutamate transmission,

Corrects the neurotransmission imbalance post withdrawal and reduces craving

Question 25

MOA of Naltrexone

Answer 25

Blocks opioid receptors

Reduce rewarding effect mediated by endorphin system

Question 26

MOA of Disulfiram

Answer 26

Psychological deterrent
Anti craving effect through increased dopamine transmission
Potential rare but severe side effects
Low compliance

Question 27

List the psychosocial interventions in relapse prevention

Answer 27

Cognitive Behavioural Therapy

Motivational Enhancement Therapy

12 Step Facilitation Therapy (eg AA

Family and Couple Therapy