Alcohol Use Disorders Flashcards
How much is 1 unit of alcohol?
10ml
Epidemiology of alcohol use disorder
M:f::2:1
Female alcoholism is probably unreported
8% of all patients admitted hospital are at risk of alcohol withdrawal
Definition of hazardous drinking
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
Definition of harmful drinking
A pattern of alcohol consumption that is causing mental or physical damage
W>35units
M>50 units
Definition of alcohol dependance
A cluster of behavioural, cognitive and physiological factors that typically include a strong desire to drink alcohol and difficulties in controlling its use
DSM IV classification of alcohol use disorders
Two distinct disorders: alcohol abuse and alcohol dependence
Specific criteria for each
DSM 5 classification of alcohol use disorders
Integrates alcohol abuse and alcohol dependence (DSM IV) into a single disorder called ‘alcohol use disorder’ (AUD).
Mild, moderate or severe
DSM 5 criteria for alcohol use disorder (9)
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
What is tolerance (DSM5 criteria)?
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.
What is withdrawal according to DSM 5 criteria?
The characteristic withdrawal syndrome for alcohol
Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.
Determining severity of alcohol use disorder
Mild - 2 to 3 symptoms
Moderate- 4 to 5 symptoms
Severe - 6+ symptoms
List the screening tools for identifying AUD
- CAGE
- AUDIT
- FAST
- Severity of alcohol dependance questionnaire (SAD-Q)
- Clinical Institute Withdrawal Assessment for Alcohol (CIWA-AR) - 10 item scale used in assessment and management
Features of severity of alcohol dependance questionnaire
Physical withdrawal Affective withdrawal Withdrawal relief drinking Alcohol consumption Rapidity of reinstatement
Intervention techniques
- Brief intervention
- Motivational enhancement therapy
- Medical assisted detoxification (only if dependant)
- Relapse prevention - psychosocial Intervention and pharmacological treatment
Indications for brief intervention
Audit score between 8-20
Acronym ‘FRAMES’
Features of brief intervention
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.
Features of motivational enhancement therapy
Indicated in harmful drinking
Expression of empathy
- use reflective listening
- to sidestep resistance rather than confrontational approach
Support self efficacy
Indication of medication assisted detoxification
If brief intervention and motivational enhancement therapy is not working
If patient has withdrawal syndrome
What are commonly experienced withdrawal symptoms
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
Describe complicated withdrawal
Seizures
Hallucinosis
Delirium Tremens
Wernicke-Korsakoff Syndrome
Drug used in medical assisted detoxification
Chlordiazepoxide
SE of drug used in detoxification
High rate of relapse
Cognitive impairment, cumulative neuronal damage
Kindling effect - severity of withdrawal symptoms Increase after each alcohol withdrawal
Drugs used in pharmacological prevention of relapse
Acamprosate
Naltrexone
Disulfiram
MOA of Acamprosate
Action on GABA and Glutamate transmission,
Corrects the neurotransmission imbalance post withdrawal and reduces craving
MOA of Naltrexone
Blocks opioid receptors
Reduce rewarding effect mediated by endorphin system
MOA of Disulfiram
Psychological deterrent
Anti craving effect through increased dopamine transmission
Potential rare but severe side effects
Low compliance
List the psychosocial interventions in relapse prevention
Cognitive Behavioural Therapy
Motivational Enhancement Therapy
12 Step Facilitation Therapy (eg AA
Family and Couple Therapy
