Alcohol Use Disorders

Question 1

Temperance movement

Answer 1

Began in the 1784 when Dr. Benjamin Rush documented problems of heavy drinking including:

• jaundice
• delirium
• seizures

first documented cases of alcohol poisoning/addiction

Question 2

What year was the peak of alcohol consumption in the US

Answer 2

1980

Question 3

What percentage of Americans abstain?

Answer 3

30 percent of Americans

Question 4

How does education and alcohol consumption correlate

Answer 4

Positive linear correlation

Question 5

Where is most alcohol absorbed?

Answer 5

Small intestine (most)

Stomach (the rest)

*slower if food or water is in the stomach, faster if carbonated beverages are present *

Question 6

Metabolism of alcohol

Answer 6

Zero pass metabolism in the liver
- 0.25 ounces per hour

Alcohol -> Ethanol acetaldehyde -> acetic acid
* ethanol acetaldehyde build up is toxic and makes you puke*

Question 7

Alcohol use disorder DSM-5 difference

Answer 7

Alcohol use disorder (AUD) with mild/moderate/severe sub-classifications
- needs at least 2 of the 11 criteria in a 12 month period

Question 8

Alcoholics Anonymous

Answer 8

Established in 1935. Follows the “12 step” program

Better for maintenance but not actually that good for stopping first

Question 9

Acamprosate

Answer 9

Indicated for abstinence from alcohol in patients dependent

- blocks NMDA receptors and lowers cravings

Question 10

Disulfriam (antibuse)

Answer 10

Blocks aldehyde-dehydrogenase and induces toxicity and vomiting when someone drinks

Used in patients who want to remain in a state of enforced sobriety.
- very challenging to get a patient on but is very good

Question 11

Naltrexone

Answer 11

Indicated for the treatment of alcohol dependence
- blocks m-opioid receptors and stops dependence

• can be in oral or extended injectable forms*
• injectable forms are only used in patients who can show they are trying to remain abstain from alcohol in outpatient settings

Question 12

How to handle alcohol withdrawal

Answer 12

Dont drink non-caffeinated fluids
Take multivitamin
Take oral thiamine

*once hitting alcoholic psychosis and delirium tremens (use benzos)

Question 13

What cytochrome p450 enzyme is hyperactive in chronic alcohol use and contributes to tolerance?

Answer 13

CYP2E1

• if taking alcohol, can decrease metabolism of certain drugs including the following:*
• anesthetics
• acetaminophen
• eszopiclone

these drugs would also increase metabolism if the alcoholic is not drinking currently

Question 14

Why do women often tend to be susceptible to alcohol effects more than men?

Answer 14

Women tend to:

• weigh less
• low weight = more susceptible*
• have higher proportion of body fat
• increased body fat = more susceptible*
• less alcohol dehydrogenase activity
• lower = more susceptible*

Question 15

High yield effects of alcohol on common receptors and drugs

Answer 15

Barbiturates and benzos = synergistic effect

Glutamate = 
Anataognist effect (blocks receptors and also turns GABAa on more)

Question 16

High yield alcohol related diseases

Answer 16

Dilated cardiomyopathy

Myocarditis

Gastritis

Liver cirrhosis and disease

Polyneuropathy

Wernickes-korsakoff syndrome
- dangerous low levels of thiamine

Marchiafava-bignami disease
- degeneration of corpus callosum

Question 17

Stages of change

Answer 17

1) pre-contemplation
- no intention on changing behavior but will listen to sentiment
- doesn’t believe they have a problem

2) contemplation
- knows there is a problem and is willing to listen to sentiment
- there is no commitment to action though

3) preparation
- same as 2 except now there is a commitment to action

4) action
- active modification for he behavior

5) maintenance
- sustained changes of new behavior replacing old

6) relapse
- fall back into old patterns fo behavior