Alcohol use disorders

alcohol abuse
effects on body

1. ALCOHOL USE DISORDERS VYJAYANTHI KADAMBI INTERN MMCRI

2. A drug is defined (by WHO) as any substance that, when taken into the living organism, may modify one or more of its functions. This definition conceptualises ‘drug’ in a very broad way, including not only the medications but also the other pharmacologically active substances.

3. A psychoactive drug is one that is capable of altering the mental functioning. 1. Acute intoxication, 2. Withdrawal state, 3. Dependence syndrome, and 4. Harmful use.

4. Acute Intoxication Acute intoxication is a transient condition following the administration of alcohol or other psycho active substance, resulting in disturbances in level of consciousness, cognition, perception, affect or behaviour, or other psychophysiological functions and responses. This is usually associated with high blood levels of the drug.

5. Withdrawal State A withdrawal state is characterised by a cluster of symptoms, often specific to the drug used, which develop on total or partial withdrawal of a drug, usually after repeated and/or high-dose use. This, too, is a short-lasting syndrome with usual duration of few hours to few days.

6. Dependence Syndrome cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviours that once had greater value at least three of the following have been experienced or exhibited at sometime during the previous year desire or sense of compulsion Difficulties in controlling withdrawal state Tolerance Progressive neglect of alternative pleasures or interests Persisting with substance use despite clear evidence of overtly harmful consequences

7. The major dependence producing drugs are: 1. Alcohol 2. Opioids, e.g. opium, heroin 3. Cannabinoids, e.g. cannabis 4. Cocaine 5. Amphetamine and other sympathomimetics 6. Hallucinogens, e.g. LSD, phencyclidine (PCP) 7. Sedatives and hypnotics, e.g. barbiturates 8. Inhalants, e.g. volatile solvents 9. Nicotine, and 10. Other stimulants (e.g. caffeine).

8. ALCOHOL USE DISORDERS Jellinek – Patterns of drinking ALPHA BETA GAMMA DELTA EPSILON Spree drinking or dipsomania Cloninger classification – Type 1 and Type 2 late second or early third decade Males Insidious onset If the onset occurs late in life, especially after 40 years of age, an underlying mood disorder should be looked for

9. In DSM- 5, the previous categories of ‘alcohol abuse’ and ‘alcohol dependence’ used by DSM were integrated into a single ‘alcohol use disorder’ (AUD) with mild, moderate, and severe subclassifications . Anyone meeting two of the 11 criteria in a 12- month period receives a diagnosis of AUD; the severity grading is based on the number of criteria met

10. Single screening question for unhealthy alcohol use • How many times in the past year have you had five (four for women) or more drinks in a day? • The question may be preceded by ‘Do you sometimes drink beer, wine or other alcoholic beverages?’ • A response of one or greater indicates unhealthy use. • Note: different thresholds are sometimes used for the number of drinks, depending on standard drink size and national guidelines.

11. Lab Markers GGT CDT AST ALT ALP MCV URIC ACID BLOOD TRIGLYCERIDES

12. SCREENING TESTS CAGE QUESTIONAIRE AUDIT MAST

13. Acute alcohol intoxication

14. Withdrawal syndrome Hangover – most common Tremors – next Nausea and vomiting weakness, irritability, insomnia and anxiety delirium tremens, alcoholic seizures and alcoholic hallucinosis .

15. CHRONIC COMPLICATIONS WERNICKE’S ENCEPHALOPATHY KORSAKOFF PSYCHOSIS MACHIAFAVA- BIGNAMI DISEASE

16. Other Complications These include: i . Alcoholic dementia. ii. Cerebellar degeneration. iii. Peripheral neuropathy. iv. Central pontine myelinosis .

17. Gastrointestinal System i . Fatty liver, cirrhosis of liver, hepatitis, liver cell carcinoma, liver failure ii. Gastritis, reflux esophagitis, esophageal varices, Mallory-Weiss syndrome, achlorhydria, peptic ulcer, carcinoma stomach and esophagus iii. Malabsorption syndrome, protein-losing enteropathy iv. Pancreatitis: acute, chronic, and relapsing

18. Central Nervous System i . Peripheral neuropathy ii. Delirium tremens iii. Rum fits (Alcohol withdrawal seizures) iv. Alcoholic hallucinosis v. Alcoholic jealousy vi. Wernicke- Korsakoff psychosis vii. Marchiafava-Bignami disease viii. Alcoholic dementia ix. Suicide x. Cerebellar degeneration xi. Central pontine myelinosis xii. Head injury and fractures.

19. Miscellaneous i . Acne rosacea, palmar erythema, rhinophyma, spider naevi , ascitis , parotid enlargement ii. Foetal alcohol syndrome (craniofacial anomalies, growth retardation, major organ system malformations) iii. Alcoholic hypoglycaemia and ketoacidosis iv. Cardiomyopathy, cardiac beri-beri v. Alcoholic myopathy vi. Anaemia , thrombocytopenia, Vitamin K factor deficiency, haemolytic anaemia vii. Accidental hypothermia viii. Pseudo-Cushing’s syndrome, hypogonadism, gynaecomastia (in men), amenorrhoea , infertility, decreased testosterone and increased LH levels ix. Risk for coronary artery disease x. Malnutrition, pellagra xi. Decreased immune function and proneness to infections such as tuberculosis xii. Sexual dysfunction

20. Social Complications i . Accidents ii. Marital disharmony iii. Divorce iv. Occupational problems, with loss of productive man-hours v. Increased incidence of drug dependence vi. Criminality vii. Financial difficulties.

21. TREATMENT i . Ruling out (or diagnosing) any physical disorder. ii. Ruling out (or diagnosing) any psychiatric disorder and/or co-morbid substance use disorder. iii. Assessment of motivation for treatment. iv. Assessment of social support system. v. Assessment of personality characteristics of the patient. vi. Assessment of current and past social, interpersonal and occupational functioning.

22. The treatment can be broadly divided into two categories which are often interlinked. These are detoxification and treatment of alcohol dependence

23. Detoxification is the treatment of alcohol withdrawal symptoms, i.e. symptoms produced by the removal of the ‘toxin’ (alcohol). The best way to stop alcohol (or any other drug of dependence) is to stop it suddenly The usual duration of uncomplicated withdrawal syndrome is 7-14 days. The aim of detoxification is symptomatic management of emergent withdrawal symptoms. The drugs of choice for detoxification are usually benzodiazepines. Chlordiazepoxide (80-200 mg/day in divided doses) and diazepam (40-80 mg/day in divided doses) are the most frequently used benzodiazepines.

24. preparation of vitamin B containing 100 mg of thiamine (vitamin B1) should be administered parenterally, twice everyday for 3-5 days. This should be followed by oral administration of vitamin B1 for at least 6 months. Care of hydration is another important step; it is extremely important not to administer 5% dextrose (or any carbohydrate) in delirium tremens (or even in uncomplicated alcohol withdrawal syndrome) without thiamine.

25. Always give thiamine parenterally before the administration of glucose solutions where there is a suspicion of chronic heavy alcohol use, to avoid precipitating Wernicke’s encephalopathy.

26. Treatment of Alcohol Dependence Behaviour therapy- Aversion therapy Psychotherapy Group therapy- Alcoholics Anonymous (AA) Deterrent agents- Disulfiram 250-500 mg/day Other deterrent agents 1. Citrated calcium carbimide 2. Metronidazole. Anti-craving agents- Acamprosate , Naltrexone Psychosocial rehabilitation

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