Lecture 41: Alcohol Abuse and Dependence Flashcards
What is epidemiology of alcohol use disorder?
8 million have alcohol dependence
9.7 million abuse alcohol
How many people with alcohol abuse or dependence received treatment?
20%
What is a big problem with alcohol dependence?
The problem is that physicians don’t ask about alcohol
-alcoholism is likely to be seen as a moral problem even though addiction is a disease
What is alcoholism?
Any use of alcoholic beverages that causes any damage to the individual or society or both
What are indicators of alcohol dependence/abuse?
Family complaints
Work problems
Medical problems
Arrests
What is the DSM-IV-TR criteria for alcohol ABUSE?
Maladaptive pattern of alcohol use leading to clinically significant impairment or distress, manifested within a 12 month period by:
- Failure to fulfill role obligations at work, school, etc.
- Recurrent use in hazardous situations
- Legal problems related to alcohol
- Continued use despite alcohol-related social/interpersonal problems
What are the DSM IV TR criteria for alcohol DEPENDENCE?
- Tolerance
- Alcohol withdrawal signs or symptoms
- Drinking more than intended
- Unsuccessful attempts to cut down on use
- Use despite physical or psychological consequences
- Excessive time related to drinking or its effects
- Impaired social or work activities due to alcohol
What is alcohol dependence with physiological dependence? Significance?
Alcohol dependence accompanied by tolerance and/or withdrawal
More severe clinical course
Higher relapse rate
What are symptoms of alcohol withdrawal?
- Autonomic HYPERACTIVITY
- Hand TREMOR
- DELIRIUM TREMENS
-could be fatal
-hallucinations
-cardiovascular fatality - insomnia
- agitation
- anxiety
Basically the opposite of sedated
What is the etiology of alcohol dependence?
Approximately 50% of risk is due to genetic factors
- Can interact with one another or with environmental factors
- may arise in individuals with no known history of alcohol dependence
What are the treatment stages for alcohol abuse?
Stage 1: Identification
Step 2: Detox/withdrawal
Step 3: Rehabilitation
Step 4: Aftercare
What is the CAGE questionnaire for alcoholics? Significance?
Have you ever felt you should CUT down on your drinking
Have people ANNOYTED you by criticizing your drinking?
Have you ever felt bad or GUILTY about your drinking
Have you ever had a drink first thing in the morning to steady your nerves/egget rid of hangover (e.g. EYE-OPENER)
If person answered YES to 2 OF 4, then more assessment is required
What is the AUDIT test?
Screening for harmful drinking
Alcohol Use Disorders ID test
Weeds out those who are pressured to drink with others
What are the pharmacological therapies for alcohol WITHDRAWAL?
- benzodiazepines
- Beta-blockers (less synmpathetic response)
- Alpha agonists (alpha adrenergic is INHIBITORY)
- Anticonvulsant
What are types of psychosocial interventions used to treat EtOH DEPENDENCE?
- CBT and motivational enhancement therapy
- 12 step program
- counseling
- vocational rehabilitation
All show a large reduction in drinking days
What are the medications approved in the US to treat alcohol DEPENDENCE?
- Disulfiram
-fucks with aceltaldehyde dehydrogenase…so you feel like shit when you drink - Naltrexone
38% better chance of remaining alcohol abstinence - Acamprosate
- Long-acting naltrexone (Vivitrol)
What is the problem with medications for alcohol dependence?
They are not given out enough!
What are the side effects of Naltrexone? Significance?
- Nausea
- headaches
- dizziness
- fatigue
So no major side effects
According to Kranzler, Naltrexone is WOEFULLY underprescribed
-no reasons for giving this
What is the MOA of Naltrexone? Significance?
Opiate blocker Contraindication for i. current use of opioids ii. medical disorders requiring opioid analgesics iii. pregnancy or breastfeeding
What is Vivitrol?
Long-acting naltrexone -injected -once monthly dosing -treats alcohol abuse Approved to be given to patients who are ALREADY abstinence…maintenance of abstinence
What is acamprosate? Significance?
One of the medications you can use with alcohol dependence Hard to be compliant with No abuse potential Side effects include -renal insufficiency -Diarrhea
What is significance of Topiramate?
Generic and is not going to be ever approved with FDA
Decreases heavy drinking
Kranzler thinks topiramate works best…but you have to increase dosage slowly
Patients want to deal with side effects because this shit actually works?
Makes carbonated drinks taste turrible
What are side effects of topiramate?
Numbness and tingling Sleepiness Loss of appetite Weight loss Language problems Depression Suicidal thoughts or actions
