Alcohol misuse and dependence

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Alcohol misuse and dependence

• Dr. Mohamed Shekhani

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Introduction

• Alcohol consumption associated with social,
  psychological physical problems constitutes
  harmful use.
• Approximately one-quarter of male patients in
  general hospital medical wards in the UK have a
  current or previous alcohol problem.

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Aetiology

• Availability of alcohol
• social patterns of use appear to be the most
  important factors.
• Genetic factors may play some part in
  predisposition to dependence.
• The majority of alcoholics do not have an
  associated psy-chiatric illness, but a few drink
  heavily in an attempt to relieve anxiety or
  depression

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Diagnosis

• Alcohol misuse may emerge during the
  patients history, although patients may
  minimise their intake.
• It may also present via its effects on one or
  more aspects of the patients life.
• Alcohol dependence commonly presents with
  withdrawal in those admitted to hospital, as
  they can no longer maintain their high
  alcohol intake.

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Diagnosis
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Complications of chronic alcohol misuse

• Social problems
• Absence from work
• Unemployment
• Marital tensions
• Child abuse
• Financial difficulties
• Problems with the law, such as violence traffic
  offences.

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Complications of chronic alcohol misuse

• Psychological problems
• 1.Depression is common Alcohol has a direct
  depressant effect heavy drinking creates
  numerous social problems. Attempted completed
  suicide are often associated with alcohol misuse.
• 2. Anxiety is relieved by alcohol. People
  socially anxious may use alcohol develop
  dependence alcohol withdrawal incr anxiety.
• 3. Alcoholic hallucinosis is a rare condition in
  which alcoholic individuals experience auditory
  hallucination in clear consciousness.
• Alcohol withdrawal Symptoms usually become
  maximal about 2 days after the last drink and can
  include seizures (rum fits).
• 4.Delirium tremens delirium associated with
  severe alcohol withdrawal. With significant
  mortality and morbidity

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Brain effects

• 1.The familiar features of drunkenness are
  ataxia, slurred speech, emotional incontinence,
  aggression.
• 2. alcoholic blackouts Very heavy drinkers
  may experience periods of amnesia for events
  during bouts of intoxication.
• 3.Alcoholic dementia from Established
  alcoholism with global cognitive impairment
  resembling Alzheimers disease, but which does
  not progressmay even improve on abstinent.
• 4.Indirect effects on behaviour can result from
  head injury, hypoglycaemia encephalopathy.

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Brain effects

• 5.WernickeKorsakoff syndrome, A rare but
  important effect of chronic alcohol misuse an
  organic brain disorder results from damage to the
  mamillary bodies, dorsomedial nuclei of the
  thalamusadjacent areas of periventricular grey
  matter. It is caused by a deficiency of thiamin
  (vitamin B1), which is most commonly caused by
  long-standing heavy drinking an inadequate
  diet.
• Without prompt treatment, the acute presentation
  of Wernickes encephalopathy (nystagmus,
  ophthalmoplegia, ataxia, confusion) can progress
  to the irreversible deficits of Korsakoffs
  syndrome (severe short-term memory deficits
  confabulation).
• In those who die in the acute stage, microscopic
  examination of the brain shows hyperaemia,
  petechial haemorrhagesastrocytic proliferation

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Other effects

• These are protean virtually any organ
  can be involved alcohol has replaced syphilis
  as the great neurological mimic.

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Management advice

• Clear information from a doctor about the harmful
  effects of alcohol safe levels of consumption
  is often all that is needed.
• In more serious cases, patients may have to be
  advised to alter leisure activities or change
  jobs if these are contributing to the problem.

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ManagementPsychological

• Psychological treatment is used for patients who
  have recurrent relapses usually available at
  specialised centres.
• Support is also provided by voluntary
  organisations, such as Alcoholics Anonymous (AA)
  in the UK.
• If alcohol dependence is suspected, withdrawal
  syndromes can be prevented, or treated once
  established, with benzodiazepines.
• Large doses may be required (e.g. diazepam 20
  mg 6-hourly), tailed off over a period of 57
  days as symptoms subside.

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ManagementWKC

• Prevention of the WernickeKorsakoff complex
  requires the immediate use of high doses of
  thiamin( parenteral Pabrinex)
• There is no treatment for Korsakoffs syndrome
  once it has arisen.
• The risk of side-effects, such as
  respiratory depression with benzodiazepines
  anaphylaxis with Pabrinex, is small when weighed
  against the risks of no treatment.

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Managementdrugs

• Disulfiram (200400 mg daily) can be given as a
  deterrent to patients who have difficulty
  resisting the impulse to drink after becoming
  abstinent. It blocks the metabolism of alcohol,
  causing acetaldehyde to accumulat when
  alcohol is consumed, an unpleasant reaction
  follows with headache, flushing and nausea.
• Disulfiram is always adjunct to other, esp
  supportive psychotherapy
• Acamprosate (666 mg 8-hourly) has recently been
  introduced to maintain abstinence by reducing the
  craving for alcohol.
• Only rarely are antidepressants required
  depressive symptoms, if present, usually
  resolve with abstinence.
• Antipsychotics (e.g. chlorpromazine 100 mg
  8-hourly) are required for alcoholic
  hallucinosis.

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prognosis

• Many but not all who become dependent on alcohol
  relapse after treatment.
• Chronic alcohol misuse greatly increases the risk
  of death from accidents, disease suicide.

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Single choice Qs

• 1. Psychiatric complications of chronic alcohol
  abuse include all except
• A.Depresion.
• B.Anxiety.
• C.Bipolar disease.
• D.Hallucinations.
• E. Delirium.

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Single choice Qs

• 2. Now the great neurological mimic is
• A. Syphilis.
• B.Alcoholism.
• C. MS.
• D. B12 deficiency.
• E.TB.

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Single choice Qs

• 3. Regarding chronic alcoholism brain effects,
  all are reversible by abstinence except
• A. Korsakof syndrome.
• B.Acute Korsakof encephalopathy.
• C. Alcohol dementia.
• D. Cerebellar ataxia.
• E. Alcoholic blackouts.

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Single choice Qs

• 14. The following help alcoholics by reducing
  craving to alcohol
• A.Disulpharam.
• B. Accomprosate.
• C. Vitamin B1.
• D. Benzodiazepines.
• E.Antibiotics.