Clinic and treatment alcoholism

1
Clinic and treatment alcoholism

• P. Verbank
• Clinic for treatment of alcoholism and toxic
  manias
• Hospital University Center Bergmann, Brussels

2
Problems connected with alcoholism

• In Belgium, among people at the age of 18 and
  older
• 70 to 80 drink alcohol
• 20 have problems with alcohol
• 5 are already alcoholics

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In youngsters

• First contact with alcohol
• Getting accustomed to regular consumption
• First problems with alcohol

4
First contacts with alcohol

• in the family
• with friends
• with curiosity
• on a certain occasion
• .

• unpleasant
• neutral
• interesting

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Neutral
Time to time consumption
6

• Unpleasant
• unpleasant taste
• unpleasant effect
• .

Repeated
7
Pleasant Interesting
Repeated consumption
Drinking problems
8
Problems with the use of alcohol

• Difficulties with taking control over consumption
• Drunkenness
• Accidents
• Health damages
• Dependence

9
Consumption Drinking problems

• Habit
• Taste
• Effect expectations
• Looking for risk
• Use of other substances
• Stress exposure
• Depression, sadness
• ..

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Reinforcing effect of the substances

• A substance may have a reinforcing effect if its
  consumption changes the chances for repeated
  consumption
• Positive reinforcement
• Negative reinforcement

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Positive reinforcement of the consumption

• Primary factors Euphoria, Pleasure ,
   Stimulation , etc.
• Secondary factors anxiolyse, antidepressor
  effect, effect on sleep etc.
• Tertiary factors control of symptoms during
  abstinance

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Classic model for adaptation

• Consumption
• Repeated consumption
• Tolerance
• Increase of consumption
• Physical dependence

13

•  Contrary to sedative substances like alcohol,
  barbiturates and other opiates, psycho stimulants
  do not lead to physical dependence!

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Cocaine and amphetamineMode of action

• Increase in the quantity of noradrenaline and
  dopamine at the level of synaptic cleft..
• Noradrenergic system responisble for high
  spirits
• Dopaminergic system responsible for the
  regulation of movements, and also for circle of
  recompense

15

• Induction of euphoria in the beginning of
  consumption can be observed in almost all
  substances which cause addiction
• The anatomical substrate of this activity is the
  activation of mesolimbic dopaminergic process,
  consisting natural part circle of recompense

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Drugs abused by humans preferentially increase
synaptic dopamine concentration in the mesolimbic
system of freely moving rats. Di Chiara G,
Imperato A, PNAS 85, 5274, 1988.
17
If psychostimulants did not lead to tolerance
development ,then what would happen with the
repetition of consumption?
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Psychostimulants Behaviour sensibility

• Repetative and intermittant consumption
• Progressive increase in motor response
• Parallel increase in the release of dopamine at
  the level of limbic system
• Where does the progressive increase of
  stimulating effect come from?

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PsychostimulantsBehavioral sensibility

• Increased during stress exposure
• Role of glucocorticoids?

Locomotive activity at intervals of 60 mins
after injection
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Repeated consumption of toxicomanogenetic
substances tolerance or sensibility?
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Repeated consumption of toxicomanogenetic
substances

• Tolerance in relation to possible sedative effect
  of the substance
• Sensibility in relation to stimulative (leading
  to euphoria) effects of the substance

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Behavioral sensibility

• .
• Progressive increase of motor response during
  repetitive comsumption of psychostimulants.
• Parallel increase in the release of dopamine in
   circle of recompense  leading to increase of
  reinforcing effect of the products and loss of
  control over consumption.
• Crossed for psychostimulant ,alcohol,opiates,
  etc.
• Accent on the exposition of stress factors
• Irreversiblity during continuous consumption?
• Parallel modification of genetic expression.

23
Substance qualities leading to addiction

• Reinforcing effect ( wish of consumption or
   craving )
• Tolerance
• Pharmaco-dependence
• Behavior sensibility
• Consequences loss of control over consumption
  and behavior.

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Models of addiction

• Actual
• Consumption
• Reinforcing effect and repetitive comsumption
• Sensibility and loss of control over consumption
• Tolerance
• Physical dependence

• Classic
• Consumption
• Continuous consumption
• ?olerance
• Increase in consumption
• Physical dependence

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Natural reinforcing substance(Food Liquids, etc.)
Intensity
desire for consumption
consumption
Time
Stimulus X
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Substances leading to addiction
intensity
Desire for consumption
consumption
Time
Stimulus X
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Alcohol - Epidemiology

• 1 adult out of 20 is addicted (about 300.000
  alcoholics in Belgium)
• 1adult out of 5 has problems with consumption

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Expected life duration for a person addicted to
alcohol52 years
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Alcoholism Mortality
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Drinking problems

• Excessive consumption
• Alcohol abuse
• Alcohol dependence
• Pathological drunkenness

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Alcohol dependence

• Loss of control
• Way of life orientated towards consumption
• Dependence
• Pharmaco-dependence

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Reasons for alcoholism

• On substance behalf
• Accessibility
• Reinforcing activity
• On environmental behalf
• Stress factors
• Positive adjustment in the society to alcohol
• On patients behalf
• Genetic factors
• Comorbidity

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Alcoholism risk groups

• High risk environment
• Positive family story
• Previous dependence on other substances
• Psychological problems
• Searching for new sensations
• Searching for a psycotropic effect of alcohol
• (Marks?)

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Alcoholism Late identification

• Cyrosis
• Polineurit
• Cerebral atrophy
• Compulsive consumption
• Social degradation
• ....

35
Alcoholism significant signs

• Problems with digestive system
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• Accidents
• Sadness/depression
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