Substance Use Disorder: Alcohol

Question 1

Define alcohol dependence.

Answer 1

Alcohol consumption high enough to cause substantial physical, psychological and social harm.

Risk:

• Low (under 21/14 units M/F)
• Hazardous (22-50/15-35 units/wk M/F)
• High (M>50, F>35).

Question 2

Explain the aetiology/risk factors for alcohol dependence.

Answer 2

Multifactorial

Genetic basis with social drives.

Associated with culture, religion, FHx, availability and price of alcohol

Male gender

Question 3

Summarise the epidemiology of alcohol dependence.

Answer 3

1% drink harmfully UK.

Question 4

What is the ICD-10 criteria for dependence syndrome?

Answer 4

Strong desire or sense of compulsion

Difficulties in controlling substance taking – LACK OF CONTROL is key for diagnosis

Physiological withdrawal

Evidence of tolerance – need more to gets same effect

Progressive neglect of other aspects of life

Persisting use even after bad experiences

Question 5

What are signs of acute intoxication?

Answer 5

Appearance: Smell, uncoordinated

Speech: Slurred

Mood: Variable, labile

Thought: Variable

Perception: Hallucinations

Cognition: Confused

Insight: Poor

Question 6

What are signs of delirium tremens?

Answer 6

Symptoms appear after 48-72h of drinking cessation

Appearance: Agitated/fearful

Speech: Confused

Mood: Labile/anxious

Thought: Confused

Perception: Hallucination/delusion

Cognition: Confused

Insight: Poor

Question 7

What are investigations for alcohol dependence?

Answer 7

Alcohol level

FBCs

LFTs

Albumin

Clotting

Glucose

B12 folate

U+Es

Question 8

What is the management for alcohol dependence?

Answer 8

Detoxification if needed: BZD (prevent seizures) rehydraton therapy

Vitamin supplements: B12 + Pabrinex.

Motivation and self help, social issues

Question 9

What are withdrawal therapies for alcohol dependence?

Answer 9

Disulfiram: Blocks ADH leading to buildhup of premetabolyte and therefore unpleasant reaction on drinking.

Acamprosate: Reduced conditioned response and craving.

Naltrexone: Reduces reinforcing actions (‘high’)

Question 10

What are complications associated with alcohol dependence?

Answer 10

Mental: Anxiety, depression, breakdown of relationships, self harm, suicide, dementia.

Physical: GI ulcers, gastritis, HTN, arrhythmias, cirrhosis, hepatitis, jaundice, neuropathy (B12), delirium tremens (withdrawal).

Wernickes Encephaopathy: Opthalmoplegia, confusion, nystagmus. This is followed by irreversible Kosakoffs leading to confabulation + retrograde memory loss.

Question 11

What is the prognosis of alcohol dependencce?

Answer 11

Relapsing and remitting, high suicide risk.