Alcohol Misuse

Question 1

What is the recommended alcohol limits for both men and women?

Answer 1

14 units

Question 2

Why do men metabolise alcohol faster?

Answer 2

They have lower percentage of body fat

Question 3

What is the legal limit to drive after alcohol?

Answer 3

<80mg of alcohol/100ml of blood

Can still be above 80% in the morning after

Question 4

Why are women drinking more?

Answer 4

More socially acceptable
More disposable income
More drinks marketed at women
More drinking places aimed at women customers

Question 5

What are the risk factors for drinking?

Answer 5

Drinking within the family
Childhood behavioural problems
Early use of alcohol, nicotine and drugs
Poor coping responses to life events
Depression as a cause

Question 6

What are the common causes of death due to alcohol?

Answer 6

Accidents and violence
Malignancies
Cerebrovascular disease
Coronary heart disease

Question 7

What are the effects of alcohol on pregnancy?

Answer 7

Increased risk of miscarriage, low birth weight, fetal alcohol syndrome

Question 8

What is the management for people requesting help with alcohol problem?

Answer 8

1. Investigations
   Physical and mental examination
   Assess IHD, osteoporosis risk
2. Screening questions
   CAGE questionnaire
   AUDIT questionnaire
3. Treatment
   Referral to appropriate services
   Offer vitamin supplements
   Benzodiazepines for acute withdrawal
   Disulfiram (Antabuse): promotes abstinence - alcohol intake causes severe reaction due to inhibition of acetaldehyde dehydrogenase. Patients should be aware that even small amounts of alcohol (e.g. In perfumes, foods, mouthwashes) can produce severe symptoms. Contraindications include ischaemic heart disease and psychosis
   Acamprosate: reduces craving, known to be a weak antagonist of NMDA receptors, improves abstinence in placebo controlled trials

Question 9

What are the questions asked in CAGE questionaire?

Answer 9

Have you ever felt you should Cut down on your drinking?
Have people Annoyed you by criticising 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 or to get rid of a hangover (Eye opener)?

A total score of 2 or greater is considered clinically significant.

Question 10

What are the dangers of alcohol withdrawal?

Answer 10

Wernicke’s encephalopathy
Korsakoff’s syndrome
Delirium tremens

Question 11

How is Korsakoff’s diagnosed?

Answer 11

CT head

Question 12

How is delirium tremens managed?

Answer 12

1st line: benzodiazepines e.g. chlordiazepoxide. Lorazepam may be preferable in patients with hepatic failure. Typically given as part of a reducing dose protocol
carbamazepine also effective in treatment of alcohol withdrawal
phenytoin is said not to be as effective in the treatment of alcohol withdrawal seizures

Question 13

What is alcohol harm paradox?

Answer 13

People with lower income who drinks less have higher risks of hospitalisations/conditions caused by alcohol
This is may be due to higher stress levels, limited social support, poor diet/exercise.

Question 14

What is prevention paradox?

Answer 14

A prevention measure that brings a large benefit to the community confers little benefit to each individual.

Question 15

Define at risk drinking.

Answer 15

Pattern of drinking which brings about risk of physical or psychological harm.

Question 16

Define alcohol abuse (harmful drinking).

Answer 16

Pattern of drinking which is likely to cause physical or psychological harm.

Question 17

Define alcohol dependence.

Answer 17

A specific set of behavioural, cognitive and psychological response that develops after repeated alcohol abuse.