Alcohol Use Disorders

Question 1

Roughly how many units is found in each of these drinks?

Answer 1

1 pint of beer (lager) - 3 units
1 large glass of wine - 3 units
1 25ml measure of spirit - 1 units
1 bottle of wine - 9/10 units

Question 2

What percentage of the worlds population is estimated to drink alcohol and what percentage of the UK population is estimated to drink alcohol?

Answer 2

43% of the world population consumes alcohol

In UK, 80% of the population consumes alcohol

Question 3

What is thought to be the lifetime prevalence of alcohol-use disorder in the western world?

Answer 3

7% to 10%

Question 4

What is the gender ratio in alcohol-use disorder?

Answer 4

Male:female = 2:1

but it is thought that female alcohol-use disorder goes under-reported

Question 5

What percentage of hospital inpatients are admitted to hospital and experience symptoms of alcohol withdrawal?

Answer 5

8%

Question 6

What is the maximum number of units that the low-risk drinking guidelines indicate should be consumed per week?

Answer 6

men and women should not regularly drink more than 14 units per week

Question 7

What percentage of the UK population drink at hazardous or harmful levels?

Answer 7

1 in4people drink at hazardous or harmfullevels

i.e. more than 14 units/week

Question 8

What is meant by hazardous drinking?

Answer 8

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

> 14 units and <35 units per week for females
14 units and <50 units per week for males

Question 9

What is meant by Harmful drinking?

Answer 9

Pattern of alcohol consumption that is causing mental OR physical damage

> 35 units a week for women.

> 50 units a week for men.

Question 10

What is meant by Alcohol Dependence?

Answer 10

Behavioural, cognitive and physiological factors that typically include:

• a strong desire to drink alcohol
• difficulties in controlling its use

Question 11

How does the DSM V categorise Alcohol Use disorders?

Answer 11

Mild (2-3 of the symptom criteria)
Moderate (4-5)
Severe (>6)

Question 12

What is the Alcohol use disorders identification test (AUDIT) ?

Answer 12

• comprehensive 10 question alcohol harm screening tool

- developed by the World Health Organisation (WHO)

Question 13

What are the score boundaries on the AUDIT tool which would organise patients into low, increased or high risk?

Answer 13

0-7 Low risk
8-15 = increased risk
16-19 = high risk
20+ = possible dependence

Question 14

What does the Severity of Alcohol Dependence Questionnaire measure?

Answer 14

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

Question 15

What is the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-AR) ?

Answer 15

10 item scale used in assessment and management of alcohol withdrawal:

• Nausea and Vomiting
• Tremor
• Paroxysmal Sweats
• Anxiety
• Agitation
• Tactile/auditory/visual disturbances
• Headache/fuzzy head
• Orientation

Question 16

If a patient scores 0-7 on the AUDIT, how would you manage them?

Answer 16

They are low risk

=> reinforce current drinking patterns

Question 17

If a patient scores 8-15 on the AUDIT, how would you manage them?

Answer 17

They are at risk of hazardous drinking

=> Deliver a brief intervention

Question 18

If a patient scores 16-19 on the AUDIT, how would you manage them?

Answer 18

This is now Harmful drinking
=> deliver brief intervention
=> Motivational Enhancement Therapy session
=> consider prescribing options

Question 19

If a patient scores 20+ on the AUDIT, how would you manage them?

Answer 19

Comprehensive assessment

Question 20

What 6 elements should be included in a brief intervention?

Answer 20

FRAMES
Feedback - review problems caused by alcohol
Responsibility - patient responsible for change
Advice - reduction/abstinence
Menu - provide options to change behaviour
Empathy - use empathetic approach
Self-efficacy - encourage optimism

Question 21

What “States of Change” are involved in Motivational Enhancement Therapy?

Answer 21

Pre-contemplation
Contemplation
Planning
Action
Maintenance
Relapse

Question 22

What are the four principles of Motivational Enhancement Therapy?

Answer 22

• Empathise by using reflective listening
• Develop discrepancy between deeply held values and current behaviour
• Respond with empathy/understanding rather than confrontation
• Support self efficacy by building confidence in change

Question 23

What forms of psychosocial therapy can be used to prevent relapse

Answer 23

• Cognitive Behavioural Therapy (CBT)
• Motivational Enhancement Therapy (MET)
• 12 Step Facilitation Therapy
• Family and Couple Therapy

Question 24

What is the drug of choice for medically assisted alcohol detox?

Answer 24

Chlordiazepoxide

Question 25

What symptoms are usually associated with alcohol withdrawal symptoms?

Answer 25

• Tremor, sweating, nausea, retching
• Increased HR, BP
• Anxiety/agitation
• Insomnia
• Auditory, visual, tactile hallucinations
• Withdrawal seizures (0-48 hours)
• Delirium tremens (48-72 hours) coarse tremor, confusion, delusions, hallucinations

Question 26

What are the main complications of withdrawal?

Answer 26

• Seizures
• Hallucinosis
• Delirium Tremens
• Wernicke-Korsakoff Syndrome

Question 27

What medications are licensed to prevent alcohol use relapse in the UK after successful withdrawal?

Answer 27

Acamprosate
Naltrexone
Disulfiram

Question 28

How does acamprosate act to reduce alcohol use relapse?

Answer 28

• Acts on GABA and Glutamate transmission
• corrects the neurotransmission imbalance post withdrawal
  => reduces craving

Question 29

How does naltrexone prevent alcohol use relapse?

Answer 29

• Blocks opioid receptors

- Reduces reward effect mediated by endorphin system/opioid pathway

Question 30

How does disulfiram prevent alcohol use relapse?

Answer 30

• Alcohol and Disulfiram cause unpleasant/dangerous reaction
  => Psychological deterrent
• Anti craving effect through increased dopamine transmission