Alcoholism and Substance Abuse

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Alcoholism and Substance Abuse
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Focus

• Alcoholism

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Phenomenology

• Definitions
• Intoxication
• Addiction
• Tolerance
• Physical Dependence
• Withdrawal
• Substance Dependence
• Substance Abuse

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Intoxication

• Reversible,
• Substance-specific
• physiological and behavioral changes
• due to recent exposure to a psychoactive
  substance.

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Tolerance

• The decline in potency
• continued use
• higher doses are needed for same effect.
• Receptor mediated
• Common

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Physical Dependence

• The development of withdrawal symptoms once a
  drug is stopped.

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Withdrawal

• A physiological state
• Cessation/reduction in amount of drug
• Generally opposite of drugs normal effects.

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Addiction

• Compulsion
• Psychic, rather than therapeutic, effects

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Other Terms

• Alcoholism
• DSM-related terms
• Substance dependence
• Substance Abuse

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Epidemiology
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Substance Use
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Alcohol Dependence

• Very common
• ECA 14
• gt 10 million Americans
• Another 8 million problem drinkers
• Only 3 skid row

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Epidemiology Illicit Abuse ()
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Alcohol Dependence

• Gender
• gtgt
• Probably 2 types

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Alcohol Dependence Age

• More common in adults, but...
• Teenage also common
• 15 HS 5 drinks/occasion/week
• 31 HS intoxicated 6/year
• Under-Dx in elderly
• ? alcohol
• ? look for prescription drugs

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Alcohol Dependence Social Factors

• More common
• Rural
• Undereducated
• Low socioeconomic
• Less likely to drink
• More likely to abuse

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Alcohol Dependence Socioeconomics

• Associated with
• Unstable marriages
• Increase risk divorce 3X
• Unstable work

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Alcohol Dependence Medical Ramifications

• 20-50 hospital admissions
• May be unrecognized
• 20 ER visits
• 80 of cirrhosis
• 33 of suicides

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Pathology
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Pathology of

• Acute Physiological
• Tolerance
• Withdrawal
• Addiction

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Etiology
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Etiology of Substance Abuse Genetics

• 1 parent
• 20
• 2 parents
• 20-50
• sons of father
• 50
• if severe alcoholic and criminal
• 90 risk in son.

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Genetics

• Twins
• fraternal28
• identical 54
• Adopted
• Danish Adoption Study (1974)
• adopted sons of alcoholics raised by
  non-alcoholic foster parents still had increased
  risk of alcoholism.

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Social Influences
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Diagnosis
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DiagnosisSubstance Dependence

• Maladaptive pattern of substance use
• 3 or more (1 year)
• Tolerance
• Withdrawal
• larger amounts
• Desire/Cut down
• Time spent
• Activities
• Continued use

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DiagnosisSubstance Abuse

• Maladaptive pattern
• 1 (1 year)
• recurrent use 6failed obligations
• hazardous use
• Legal problems
• Continued use despite causing interpersonal or
  social problems.
• R/O Substance dependence

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Other Diagnoses

• Substance Intoxication
• Substance Withdrawal

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DiagnosesOther substances

• Alcohol
• Amphetamines and related
• Caffeine
• Cannabis
• Cocaine
• Hallucinogens
• Inhalants
• Nicotine
• Opioids
• Phencyclidine and related
• Sedatives
• Polysubstance Abuse ( 3)
• Other

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Diagnosis

• Other Schemas for Alcohol
• Greek letters
• Typologies

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Diagnosis

• CAGE Questionnaire
• Have you ever felt the need to Cut down on
  drinking
• Have you ever felt Annoyed by criticisms of
  drinking
• Have you ever had Guilty feelings about drinking
• Have you ever taken a morning Eye opener

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Diagnosis

• Clues
• History
• Physical
• Labs

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Differential

• Normal use
• Whats normal?

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Comorbid Disorders and Complications

• Alcohol Withdrawal
• Uncomplicated
• Seizures
• Hallucinosis
• DTs

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Comorbid Disorders and Complications

• Fetal Alcohol Syndrome
• Comorbid Medical Disorders
• Comorbid Psychiatric Illnesses

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Course

• Relapses and remission
• Predictors
• Gender
• Age of onset
• Family history

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Treatment
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Treatment

• General Principles
• Alcohol
• Acute treatment Manage withdrawal
• Long term treatment Abstinence
• Question of Controlled Use

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Detox
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Long Term Treatment
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Modalities

• Groups
• Family therapy
• Medications

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Medication Treatment

• Disulfiram
• Naltrexone
• Other
• Contraindicated

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Treatment General Rules

• Supportive care
• Sobriety is goal
• Work (dont compete) with AA
• Identify triggers of relapse
• Anticipate relapses, encourage return
• Reasonable goals

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TreatmentEfficacy

• NIAAA data
• 70 recovery after 18 months
• 50 needed only minimal intervention
• abstinence related to intensity (not length) of
  tx.

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Alcoholics Anonymous

• 40 retention in 12 months

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