Lecture 41: Alcohol Abuse and Dependence

Question 1

What is epidemiology of alcohol use disorder?

Answer 1

8 million have alcohol dependence

9.7 million abuse alcohol

Question 2

How many people with alcohol abuse or dependence received treatment?

Answer 2

20%

Question 3

What is a big problem with alcohol dependence?

Answer 3

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

Question 4

What is alcoholism?

Answer 4

Any use of alcoholic beverages that causes any damage to the individual or society or both

Question 5

What are indicators of alcohol dependence/abuse?

Answer 5

Family complaints
Work problems
Medical problems
Arrests

Question 6

What is the DSM-IV-TR criteria for alcohol ABUSE?

Answer 6

Maladaptive pattern of alcohol use leading to clinically significant impairment or distress, manifested within a 12 month period by:

1. Failure to fulfill role obligations at work, school, etc.
2. Recurrent use in hazardous situations
3. Legal problems related to alcohol
4. Continued use despite alcohol-related social/interpersonal problems

Question 7

What are the DSM IV TR criteria for alcohol DEPENDENCE?

Answer 7

1. Tolerance
2. Alcohol withdrawal signs or symptoms
3. Drinking more than intended
4. Unsuccessful attempts to cut down on use
5. Use despite physical or psychological consequences
6. Excessive time related to drinking or its effects
7. Impaired social or work activities due to alcohol

Question 8

What is alcohol dependence with physiological dependence? Significance?

Answer 8

Alcohol dependence accompanied by tolerance and/or withdrawal
More severe clinical course
Higher relapse rate

Question 9

What are symptoms of alcohol withdrawal?

Answer 9

1. Autonomic HYPERACTIVITY
2. Hand TREMOR
3. DELIRIUM TREMENS
   -could be fatal
   -hallucinations
   -cardiovascular fatality
4. insomnia
5. agitation
6. anxiety
   Basically the opposite of sedated

Question 10

What is the etiology of alcohol dependence?

Answer 10

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

Question 11

What are the treatment stages for alcohol abuse?

Answer 11

Stage 1: Identification
Step 2: Detox/withdrawal
Step 3: Rehabilitation
Step 4: Aftercare

Question 12

What is the CAGE questionnaire for alcoholics? Significance?

Answer 12

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

Question 13

What is the AUDIT test?

Answer 13

Screening for harmful drinking
Alcohol Use Disorders ID test
Weeds out those who are pressured to drink with others

Question 14

What are the pharmacological therapies for alcohol WITHDRAWAL?

Answer 14

1. benzodiazepines
2. Beta-blockers (less synmpathetic response)
3. Alpha agonists (alpha adrenergic is INHIBITORY)
4. Anticonvulsant

Question 15

What are types of psychosocial interventions used to treat EtOH DEPENDENCE?

Answer 15

1. CBT and motivational enhancement therapy
2. 12 step program
3. counseling
4. vocational rehabilitation
   All show a large reduction in drinking days

Question 16

What are the medications approved in the US to treat alcohol DEPENDENCE?

Answer 16

1. Disulfiram
   -fucks with aceltaldehyde dehydrogenase…so you feel like shit when you drink
2. Naltrexone
   38% better chance of remaining alcohol abstinence
3. Acamprosate
4. Long-acting naltrexone (Vivitrol)

Question 17

What is the problem with medications for alcohol dependence?

Answer 17

They are not given out enough!

Question 18

What are the side effects of Naltrexone? Significance?

Answer 18

1. Nausea
2. headaches
3. dizziness
4. fatigue
   So no major side effects
   According to Kranzler, Naltrexone is WOEFULLY underprescribed
   -no reasons for giving this

Question 19

What is the MOA of Naltrexone? Significance?

Answer 19

Opiate blocker
Contraindication for
	i. current use of opioids
	ii. medical disorders requiring opioid analgesics
	iii. pregnancy or breastfeeding

Question 20

What is Vivitrol?

Answer 20

Long-acting naltrexone
-injected 
-once monthly dosing
-treats alcohol abuse
Approved to be given to patients who are ALREADY abstinence…maintenance of abstinence

Question 21

What is acamprosate? Significance?

Answer 21

One of the medications you can use with alcohol dependence
Hard to be compliant with
No abuse potential
Side effects include
	-renal insufficiency
	-Diarrhea

Question 22

What is significance of Topiramate?

Answer 22

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

Question 23

What are side effects of topiramate?

Answer 23

Numbness and tingling
Sleepiness
Loss of appetite
Weight loss
Language problems
Depression
Suicidal thoughts or actions