Dependence Flashcards
What is hazardous drinking?
- pattern of alcohol consumption that increases someones risk of harm
- physical, mental health and social consequences (as in harmful use)
- hazardous drinking applies to anyone drinking over recommended limits (14 units a week) but without alcohol related problems
- moves into harmful drinking when regularly consuming over 35 units per week
What is the equation for units calculation?
strength (ABV) x volume (ml) divided by 1000
What is the recommendation for alcohol consumption levels in the UK?
No more than 14 units a week on a regular basis
What are the 7 types of cancer that alcohol is associated with?
- mouth and upper throat
- larynx
- oesophagus
- breast (in women)
- liver
- bowel
What are the 4 ways in which alcohol can cause cancer?
- damages cells
- increases damage from tobacco
- affects hormones linked to breast cancer
- breaks down into cancer causing chemicals
Name the different tools that can be used for screening alcohol use
- FAST; useful in A and E settings, quick
- AUDIT; alcohol use disorders identification test
- CAGE; screening for dependence
The FRAME acronym is used to capture the elements of a brief intervention - what does it stand for?
- 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
Describe the pathophysiology of alcohol withdrawal
- unopposed upregulated excitation
- excess glutamate activity and reduced GABA activity leads to alcohol withdrawal symptoms
- excessive glutamate activity is toxic to the nerve cell
Describe the features of alcohol dependence syndrome
- only if three or more of the following have been present together at one time during the previous year
- strong desire or sense of compulsion to take drug
- difficulty in controlling use of substance in terms of onset, termination or level of use
- physiological withdrawal state
- evidence of tolerance
- progressive neglect or other pleasures / interests because of their use / effects of substance
- persistence with use despite clear evidence of harmful consequences
Describe the features of alcohol withdrawal syndrome
- first symptoms occur within hours and peak at 24-48 hours
- restlessness, tremor, sweating, anxiety, nausea and vomiting, loss of appetite and insomnia
- tachycardia and systolic hypertension evident
- generalised seizures usually in first 24 hours
- can progress to the medical emergency delirium tremens
- in most, symptoms resolve in 5-7 days
Describe the features of delirium tremens
- 5% of cases
- peak onset within 2 days of abstinence
- often presents insidiously with night time confusion
- confusion, disorientation, agitation, hypertension, fever, visual and auditory hallucinations, paranoid ideation
- mortality 2-5% (assoc, with cardiovascular collapse and infection)
Describe the management of alcohol withdrawal
- general support; reassurance, advice etc
- benzodiazepines; cross tolerant with alcohol, use long acting agents, titrate against severity of withdrawal symptoms, reduce gradually over 7 days or more
- vitamin supplementation
- thiamine (pabrinex) as prophylaxis against wernickes encephalopathy; must be parenteral, increase dose if wernickes suspected
When would detoxing be conducted in an inpatient setting?
- severe dependence
- history of delirium tremens or alcohol withdrawal seizures
- failed community detox
- poor social support
- cognitive impairment
- psychiatric co-morbidity
- poor physical health
Describe the pharmacological interventions in relapse prevention
- disulfiram; inhibits acetaldehyde dehydrogenase leading to accumulation if alcohol ingested, leads to flushed skin, tachycardia, n+v, arrhythmias and hypotension
- acamprosate; acts centrally on glutamate and GABA systems, reduces cravings, start as soon as detox complete, continue through relapses, prescribe along with psychosocial interventions, side effects include headache, diarrhoea, nausea
Describe the psychosocial interventions in relapse prevention
- CBT (coping skills therapy)
- motivational enhancement therapy
- 12 step facilitation therapy (e.g. AA)
- behavioural self control training
- family and couple therapy
- project MATCH