GDAS Pathways into and out of alcohol misuse (DONE) Flashcards
Alcohol problems are widespread
Although only half the global population drinks, alcohol is the worlds third leading cause of ill health and premature death
There is a causal relationship between alcohol and over 60 medical conditions
3 in 10 parents in the UK say they have been drunk in front of their children
800,000 working days per year are lost due to alcohol related absences
Alcohol harm paradox
Although the more deprived areas drink less, they experience alcohol related mortality rates more than three times higher than the least deprived areas
Alcohol guidelines
A single guideline for men and women who drink regularly or frequently (most weeks): no more than 14 units a week for both men and women
If you regularly drink as much as 14 units a week, it is best to spread this evenly over 3 or more days
If you wish to cut down the amount you drink, a good way to help achieve this is to have several drink free days each week
Heavy drinking in Wales
The ONS survey found almost one in seven adults in Wales had drunk 14 units or more in a single day, higher than England and Scotland
Alcohol and health
Women who drink harmfully are 4 times more likely to have a stroke than lower risk female drinkers
Alcohol is responsible for 30% of mouth and throat cancers
Liver disease only accounts for 20% of the alcohol related death burden but accounts for 80% of the deaths
In Scotland, more than half of people who ended up in hospital because they had deliberately injured themselves said they had drunk alcohol immediately before or while doing it
Which parts of the brain are affected by alcohol and in what order?
Cortex- controls conscious thought, increases amount of GABA, lack of social inhibitions
Corpus callosum- communication with other parts of the brain, coordination and function
Cerebellum- controls balance and motor coordination
Hypothalamus- autonomic brain functions, hormone release
Brain stem- breathing, consciousness and body temperature
The chemicals in the brain involved in alcohol activity
Alcohol directly targets the brain, acting through specific systems
GABA (inhibitory) increases, causes sluggish movements and slurred speech
Glutamate (excitatory) decreases, alcohol inhibits this neuronal driver
Dopamine and serotonin increases, pleasure transmitters increased by alcohol
Why do people drink?
Relax Happy Less inhibited Fit in Confident Less anxious Celebrate Make friends Forget problems Less depressed
Alcohol addiction
Neuro-adaptations
Tolerance (ability to drink more), deficits in reward related pathway, sensitisation to environmental stimuli, negative withdrawal experience
Craving/dependence, need to drink more
How the brain is affected by alcohol
Excessive alcohol: increases GABA and dopamine, decreases glutamate, causes confusion, lack of motor control and slurred speech
Withdrawal: increases glutamate, decrease GABA and dopamine, causes hangover and tremors
Repeated withdrawal episodes: increases glutamate, decreases GABA and dopamine, causes severe seizures, increased risk of hospitalisation, anxiety, altered subjective effects of alcohol
The conditions needed for change
Motivation- motivational interviewing
Positive support- social behaviour and network therapies
A behaviour change plan- cognitive behavioural therapies
Pre-detoxification
Oral thiamine- important energy source in metabolism, poorly absorbed in dependent drinkers, deficiency can lead to Wernicke’s encephalopathy or Korsakoff’s psychosis
Pabrinex- administered either IV or IM, rapidly corrects the severe depletion of vitamin B and C
Considerations for an in-patient detox
Past history of alcohol withdrawal syndrome
Major medical or surgical problems
Major psychiatric or drug problems
Poor support or homelessness
Pregnancy
Previous alcohol related to seizures or epilepsy
Consumption of over 150 units per week
Relapse prevention
Disulfiram- blocks the processing of alcohol in the body, compliance is increase when taken under supervision, only suitable for clients pursuing abstinence
Acamprosate- restores the disrupted changes in neurobiology, alleviates alcohol cravings, no addiction potential, works in approx. 30% of people
Naltrexone- blocks the alcohol reward pathways (opioid receptor antagonist), needs liver functioning monitoring, not suitable for methadone patients or patient suing any opiates
Motivational interviewing
Motivational interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change
