Substance Misuse Flashcards
Risk factors for alcohol addiction
Genetics is up to 30-40% but can be protective
Psychological vulnerability: trauma, abuse, neglect
Psychiatric illness
Occupation and social factors
Availability
Does lowering the price of alcohol increase alcohol consumption?
Yes
Asian flush
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
Blood alcohol levels differ with exposure
Heavy drinkers metabolise alcohol faster
No shit
When gauging alcohol intake
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)
Assessing alcohol intake
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
ICD-10 guidelines for alcohol dependence requires three or more of the following:
Strong desire/compulsion to drink
Physiological withdrawal state
Evidence of significant or increased tolerance
Neglect of previous interests
Persistence despite negative consequences
Taking an alcohol history
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
Epidemiology of dependence
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
Risks of mid range severity drinking
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
Alcohol and cardiac risk
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)
What percentage of cardiomyopathy is alcohol related?
20-50% in western countries
Women are more sensitive to alcohol induced heart damage than men
CNS complications of alcohol dependence
accidental injury dementia, epilepsy marchifava bignami syndrome amblyopia wernicke-korsakoff's syndrome
Endocrine complications of alcohol dependence
infertility
gynecomastia
pseudocushings
Musculoskeletal complications of alcohol dependence
osteoporosis fractures and falls gout proximal myopathy myositis
Respiratory complications of alcohol dependence
Pneumonia
TB
Aspiration
bronchiectasis
Gastrointestinal complications of alcohol
Oral, pharyngeal and oesophageal cancers
Reflux, barritts and ulcers
Oesophageal and stomach varies
Gastric cancer
Signs of alcoholic liver disease
Weight loss, fatigue Haemophilia and failing liver enzymes Steatorrohea due to malabsorption Jaudice, pain, ascites and peripheral oedema Loss of alcohol tolerance
Alcohol use and mental health
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
Blood tests for alcohol use
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
GGT
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
Anaemia in chronic alcoholics
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
Symptoms of mild alcohol withdrawal
Seizures and hallucinations in early phase
Anxiety/agitation, tremor, nausea
tachycardia & HTN
Pyrexia and insomnia
Symptoms of severe alcohol withdrawal
Seizures and hallucinations in early phase
Confusion, paranoia and extreme agitation
Vomiting & hyperventilation
Delirium tremens (episodes of acute delirium with tremors)
Mortality of alcohol withdrawal
Up to 40% if untreated due to infections, fever and fluid loss
Less than 1% if properly treated
