alcohol abuse

Question 1

Alcohol abuse definitions

Answer 1

Harmful- non dependent but drinks despite self harm
Dependence - harmful + depence syndrome’

Low risk - less than 14U a week- (men and women)
medium -15-35U /week
High>35U per week (over 6 a day

2:1 MF, 6% lifetime prevalence -1% of uk drinks harmfully

Question 2

Aetiology and RF of alcohol abuse

Answer 2

Biological - 25/50% genetic -
enhance gaba and reduce NMDA
East asian-lower dependency rates

pyshc-
occupation - publicans, doctors, soldiers, -stress
social background -difficult upbringing
psych illness- dependence assocaited with personality disorders mania, depresia, anxiety

Question 3

Sx and hx of alcohol abuse

Answer 3

Intoxication are classic -
“whos in control, you or the drink?”- query dependence if they hesitate
features of dependence syndrome (ICD10)

Withdrawal-
4-12h- uncomplicated alcohol withdraw sx (4-12h after last drink)
tremor, sweating, insomnia, tachy, NV, anxiety, craving, hallcuination

36h- aclhol withdrawal with seizures (6-48h after drink) –seizures

48-72h - delirium tremens - (1-7 days after drink)- high mortality (10%)- disorientation, amnesia, psychomotor agitation, hallucination (lillipution (small people/animals), worse at night

Psychotic disorders- aclholic hallucinations
lillipution hallucinations
Morbid jealousy (partner is unfaithful)
amnesia

Question 4

What are the available questionnaire to ix alcohol abuse

Answer 4

CAGE is the basic one- fast to use and easy -screening
>2 positive answers-
C- have you tried to cut down
A- annoyed by people suggesting you have a problem with drinking
G- guilty about drinking?
E- ever needed a drink when you woke up (eye opener)

AE uses FAST also (>3 fast positive)
AUDIT PC- short version of AUDIT for screening

rating scales/severity of alcohol–
AUDIT (alcohol use disorder identification test)- if >20 possible dependence-continue
SADQ (Severity and depence questionaire)

others -
CIWA- severity of withdrawal
APQ-nature and extent of issues

Question 5

What are bloods and Hx ix for alcohol abuse

Answer 5

Bloods - FBC (MCV), LFT, b12, folate, ue, colitting, glucose,
Urine -drugs

Full hx - esbalish timeline and full physical exam (stigmata of liver dysf)
Lifetime pattern, current consumtion, signs of dependence (ICD10), social impact

Question 6

What is the Mx of ACUTE alcoholic withdrwal

Answer 6

Start with AUDIT questionaire for screening -
either admission for detox (if acute withdraw, weknickes) or community specialist management (less serious)

Withdrawal regimen (when detoxed can go to detox community care)
1- manage expectation-worse in 48h and dont stop

community based assited withdrawl - >15U/day or >20 on audit - 2-4 meetings/week

inpatient - over 30U/day, over 30 on SADQ, pmhx (epilepsy, DT, seizures from aclohol)

treat with --
acute-up to 7 days
outpatient - chloraziepoxide + IV/IM parbinex
Inpatient -lorazepam + parbinex
(if liver damage, use Oxazepam)

chronic -after 7d- like community - acamprostate or nalrexone, 2nd line disulfiram

idenpendently of witdrawal regimen

alcohol withdrawal seizure 36h- IV lorazepam with reducing dose
delirium tremers - oral Lorazepam + Pabrinex

Webkcikes- IV thiamin

Question 7

What are the principles of Detox management of alcohol abus

Answer 7

Community approach of chronic management (after hosp acute, or direct if not admitted)

Medication started at end of detox –
1st line - Acamprosate - remove alcohol craving
Naltrexone- les high from alcohol

2nd- Disulfiram - bad hangovers

Psychosocia -
Brief intervention in hospital + intervention -> AA, SMART recovert, change grow live (CGL)

1st line -motivational interviewing (kinda CBT)
2nd line - psycho- CBT, couples therapy
Residential abstincence centres -max 3m

Question 8

Complications of Alcohol abuse

Answer 8

Biological -
Wenkickes - B12 def - ataxia, ophtalmoplegia, confusion
tx- parbinex or develops to Korsakoffs
Korsakoffs- irreverible- amnesia, confabulation, neuropathy -big impact on life
Liver/GI- hepatitis, cirrhosis, pancreatitis, varices, gatritis
Neuro - neuropathy
cancer-bowel, breast, oesophageal, liver
CVD- HTn, cardiomypathy
foetal alcohol syndrome

psychological -
depression/mania, anxiety, psychosis, self harm
amnesia, cognitive impairment (korsakoffs or acute)
morbid jealousy, hallucinations

social - unemplyed, porr work performance, domestic abuse, poor relationships, breaking law,

prognosis - 40% die early
30% lifelone issues
3)% favorable outcomes