Alcohol Addiction Flashcards
What will you find on a history taking of an alcoholic
Symptoms of a dependant drinker Denial Overwhelming desire to drink Out of control drinking Needing increasing amounts of alcohol Withdrawal symptoms when not drinking Little interest in leisure activities Drinking through harmful effects
Symptoms of a drinker going through withdrawal - 10-72 hours after abstinence Tachycardia Hypotension Tremors Nausea and Vomiting Confusion Seizures Hallucination - Auditory or Visual Delirium Tremons – Hallucinations, Confusion, Delusions, Agitation, Seizure’s
Specific Questions to ask:
Illicit drug use
Phycological/ Social problems
Try to get story from a family member/friend
CAGE Tool - do they say yes to any of these?
Tried to Cut down?
Annoyed at people criticizing you for drinking?
Guilty for drinking?
Has this conversation been an Eye opener?
The AUDIT score - Alcohol Use Disorders Identification Test
How often do you drink?
How many units a week
How often do you have more than 6/8 units?
Not able to stop drinking once started
Failed to do normal task because of drink
Needed an alcoholic drink in the morning?
Forgot things?
Injured?
Anyone else been concerned about you?
What is the treatment of a dependant drinker?
Lifestyle:
Intervention – Motivational intervention
Advice on dangers of drinking e.g. Leaflet
Avoidance of triggers for drinking
Controlled drinking e.g. weaker drinks, don’t buy on your round, sip don’t gulp
CBT
Offer Support in Outpatient detoxification - Use community mental health team
Consider Admitting if coexisting medical problem e.g. severe depression, liver failure
What is the treatment for a withdrawing drinker?
Lifestyle:
If audit score >20 or >15 units per day, offer support during detoxification as an outpatient (Daily supervision, medications, Pabrinex as normal but just done in the community). Any patients with continuous vomiting or neurological symptoms should be admitted
Indications for inpatient detoxication – Low social support, risk of suicide, history of severe withdrawal, severe co-morbidity
Optimise Nutrition – Ensure they are eating the required calories and vitamins etc
Medical:
Tremors/Agitation - Chlordiazepoxide (Benzodiazepine), use for as little time as possible as addictive
Seizures - Lorazepam IV (Benzodiazepine)
Pabrinex – B1, B2, B6, Vit C (Thiamine deficiency can lead to Wernicke’s encephalopathy (confusion, ataxia, ophthalmoplegia) This can lead to Korsakoff’s encephalopathy (non-reversible, Hypothalamic damage with cerebral atrophy, they cannot form new memories and can even progress to coma and death)
What is the treatment for a recovered alcoholic
Lifestyle: Supportive Counselling CBT Self-help groups Social Support Graceful declining of alcohol - Don't buy on their round, sip don't gulp etc
Medical:
Calcium Acetyl Homotaurineate – Blocks GABA and NMDA receptors. Reducing cravings
Naltrexone - Competitive antagonist for opioid receptors, prevents endogenous opioid binding to receptors. Reduces pleasure from alcohol
