Substance Misuse

Question 0

Risk factors for alcohol addiction

Answer 0

Genetics is up to 30-40% but can be protective
Psychological vulnerability: trauma, abuse, neglect
Psychiatric illness
Occupation and social factors
Availability

Question 1

Does lowering the price of alcohol increase alcohol consumption?

Answer 1

Yes

Question 2

Asian flush

Answer 2

Caused by a aldehyde dehydrogenase deficiency (ALDH2)
Build up of acetaldehyde due to incomplete metabolism of alcohol
Associated with more adverse side effects of alcohol, including oesophageal Ca, reduced risk of alcohol dependance

Question 3

Blood alcohol levels differ with exposure

Answer 3

Heavy drinkers metabolise alcohol faster

No shit

Question 4

When gauging alcohol intake

Answer 4

Ask about pattern of drinking (binge, alone, early in the day)
Ask about variation over time (weekend drinking, previous heavy drinking)
Purpose of drinking (stress relief, social, need to functioning)
What you drinking is important (spirits, wine, beer)

Question 5

Assessing alcohol intake

Answer 5

Days drinking per week
ABV x vol x frequency
Max and min per day
What happens without drinks, long and short term
Any other drugs taken

Question 6

ICD-10 guidelines for alcohol dependence requires three or more of the following:

Answer 6

Strong desire/compulsion to drink
Physiological withdrawal state
Evidence of significant or increased tolerance
Neglect of previous interests
Persistence despite negative consequences

Question 7

Taking an alcohol history

Answer 7

Time they awoke, morning feelings and symptoms of withdrawal
Day activities including role competence and risk
First drink, evening and social activity. Functions of drinking
Change over time, days off, most recent drink
Sleep - ease, quality duration

Question 8

Epidemiology of dependence

Answer 8

A chronic relapsing condition
A dynamic spectrum disorder
Peak age 20-45 yrs old
Best outcomes in the most and least severe cases
5% return to stable controlled drinking without treatment

Question 9

Risks of mid range severity drinking

Answer 9

You drink too much to return to normal social drinking, but not enough to justify a total abstinence.
Stuck in severe drinking which isn’t good for anyone
Vaillang 2005

Question 10

Alcohol and cardiac risk

Answer 10

Small to moderate drinking in healthy people may be beneficial (anti thrombotic, thrombolytic and anti-atherosclerotic)
Larger amounts will probably have negative effects on the heart (cardiomyopathies, arrhythmia, HTN)

Question 11

What percentage of cardiomyopathy is alcohol related?

Answer 11

20-50% in western countries

Women are more sensitive to alcohol induced heart damage than men

Question 12

CNS complications of alcohol dependence

Answer 12

accidental injury
dementia, epilepsy
marchifava bignami syndrome
amblyopia
wernicke-korsakoff's syndrome

Question 13

Endocrine complications of alcohol dependence

Answer 13

infertility
gynecomastia
pseudocushings

Question 14

Musculoskeletal complications of alcohol dependence

Answer 14

osteoporosis
fractures and falls
gout 
proximal myopathy
myositis

Question 15

Respiratory complications of alcohol dependence

Answer 15

Pneumonia
TB
Aspiration
bronchiectasis

Question 16

Gastrointestinal complications of alcohol

Answer 16

Oral, pharyngeal and oesophageal cancers
Reflux, barritts and ulcers
Oesophageal and stomach varies
Gastric cancer

Question 17

Signs of alcoholic liver disease

Answer 17

Weight loss, fatigue
Haemophilia and failing liver enzymes
Steatorrohea due to malabsorption
Jaudice, pain, ascites and peripheral oedema
Loss of alcohol tolerance

Question 18

Alcohol use and mental health

Answer 18

Triples the risk of psychiatric diagnosis
7x risk of other substance use disorder
3x risk of smoking
2-3x mood/anxiety disorder
3-5x suicide risk

Question 19

Blood tests for alcohol use

Answer 19

Blood alcohol for recent use
Chronic use:
GGT, AST, ALT (if AST:ALT > 1.5 suggest alcoholic)
MCV and macrocytic anaemia, low platelet and neutropenia
25-50% of heavy drinkers will have elevated liver enzymes

Question 20

GGT

Answer 20

Most sensitive blood test but only positive in 30% of heavy drinkers. Less likely to be normal in young, episodic or female drinkers
50% of GGT elevation is non-alcoholic
Half life of 2 weeks, has some prognostic value

Question 21

Anaemia in chronic alcoholics

Answer 21

Macrocyclic anaemia
MCV may be increased even when folate and B12 normal
Half life of 60 days
Non-specific, may be due to other liver disease or drugs

Question 22

Symptoms of mild alcohol withdrawal

Answer 22

Seizures and hallucinations in early phase
Anxiety/agitation, tremor, nausea
tachycardia & HTN
Pyrexia and insomnia

Question 23

Symptoms of severe alcohol withdrawal

Answer 23

Seizures and hallucinations in early phase
Confusion, paranoia and extreme agitation
Vomiting & hyperventilation
Delirium tremens (episodes of acute delirium with tremors)

Question 24

Mortality of alcohol withdrawal

Answer 24

Up to 40% if untreated due to infections, fever and fluid loss
Less than 1% if properly treated