Block 33 Week 7 Flashcards
what is binge drinking?
- Heavy dinking in a single session
- Twice the daily limit
- Above 4-6 units for women
- Above 6-8 units for men
what is harmful use of alcohol?
- pattern of psychoactive substance use that damages health
- harmful patterns of use often criticized by others
Harmful use should not be diagnosed if dependence syndrome, a psychotic disorder or another specific form of drug- or alcohol-related disorder is present.
what is dependence syndrome?
- A cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviours that once had greater value.
central characteristic of dependence syndrome?
desire (often strong, sometimes overpowering) to take alcohol.
diagnostic guidelines for dependence syndrome?
- 3 of more of the following have been present together at some time during the past year:
- (a) a strong desire or sense of compulsion to take the substance;
- (b) difficulties in controlling substance-taking behaviour in terms of its onset, termination, or levels of use;
- (c) a physiological withdrawal state when substance use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same substance with the intention of relieving or avoiding withdrawal symptoms;
- (d) evidence of tolerance, such that increased doses of the psychoactive substances are required in order to achieve effects originally produced by lower doses
- (e) progressive neglect of alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or take the substance or to recover from its effects
- (f) persisting with substance use despite clear evidence of overtly harmful consequence.
- (g) Narrowing of the personal repertoire of patterns of drinking e.g. a tendency to drink alcoholic drinks in the same way regardless of social constraints that determine appropriate drinking behaviour.
tolerance?
- either a need for markedly increased amounts of a substance to achieve intoxication or desired effect.
- Or marked diminished affect with continued use of same amount of a substance.
withdrawal?
- Characteristic withdrawal syndrome for substance used or closely related or same substance taken to relieve or avoid withdrawal symptoms.
- A great deal of time is spent in activities necessary to obtain or use the substance or to recover from its effects.
7 fold inc in risk of alcoholism in?
first degree relatives of alcoholics
P300?
- abnormalities in P300 event-related potential associated with familial alcoholism > P300 predicts alcohol abuse
FH in alcoholism?
- family history
- sons of alcoholics 4x more likely to be an alcoholic than sons of non-alcoholics regardless of drinking patterns of adoptive parents
receptor involved in alcoholism?
D2 dopamine receptor
variations in ? composition leads to?
- variations in allele compositions for alcohol dehydrogenase and aldehyde dehydrogenase may contribute to risk patterns of alcoholism among oriental populations
reinforcement of alcohols effects via?
- Alcohol’s reinforcing effects are modulated by dopamine, serotonin, and GABA systems
in alc dependence
dopamine
- alcohol stimulates DA release in nucleus accumbens
- increased DA may underlie ‘craving’
5HT?
*alcohol potentiates effects of serotonin at 5-HT3 receptors
*some reports of 5-HT agonists in reducing alcohol craving
psychodynamic theories of alcoholism?
- intoxication is a gain to the patient, with disinhibition allowing the expression of aggression
- maternal overprotection is described among some alcohol problems clinic attendees
- childhood sexual abuse is more commonly reported in women alcoholics than in the general population
behavioural theory of alcoholism?
- models include drinking becoming a conditioned response to a wide range of circumstances
- modelling from parents, relatives, peers, etc. is clearly demonstrated
- The euphoriant effect - important reinforcer
other behaviour factors linked to alcoholism?
- Stress and negative life events – bereavement; separation; impending court case
type 1 alcoholic?
more dependent, anxious, rigid, less aggressive, more guilty, with either the mother or father an alcoholic
type 2 alcoholic?
early onset, severe problems, socially detached, distractible, confident, and whose behaviour is linked to a similar pattern in the biological father - can be seen as alcoholism secondary to antisocial personality disorder
epidemiology of alcohol disorders?
- rise in females; rise in adolescents
- 35 % of homeless have alcohol disorders
?% of MCP abuse alcohol
4-6%
age of onset for alcoholism?
- age of onset in late teens or 20s for males
- onset later in females, who are more likely to:
- drink alone
- delay seeking help
- have co-morbid depression
- have a stronger genetic predisposition
- develop physical complications, especially cirrhosis
higher rates of alcoholism in:
- urban areas
- divorced/ separated
- those who manufacture, or sell alcohol
- commercial travellers, frequent overseas travellers
- entertainers, doctors, journalists
- North American, Afro-Caribbean, Irish