Alcoholism and unhealthy use - PowerPoint Presentation

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Alcoholism and unhealthy use

Deya Obaidat

How to measure alcohol intake

The unit of consumption = Drink = 12 Oz of beer or wine cooler = 5 Oz of wine = 1.5 Oz distilled spirit

The effect of alcohol

Vary from one person to another. (Weight, Gender, Genetics, Rapidity of consumption, presence of food, Tolerance)

The amount of alcohol in the body can be measured by Blood Alcohol Content

- measures how many grams of alcohol in 100 gram of blood

- to convert that to mg/dl, multiply it by 1000

- alcohol in the breath gives an estimate of the blood level

In USA you are legally intoxicated if BAC > 0.08% (80 mg/

dL

)

2 standard drinks will increase your BAC by 0.05%

> 300 mg/

dL

are lethal

Increase mortality if >2-3 drinks daily in females, or >3-4 drinks in males

Medical Complications of exessive

alcohol

CVS: arrhythmia (A-fib), CMO

GI: GERD/Barrett’s, pancreatitis, Hepatitis and cirrhosis

Metabolic:

lytes

abnormalities (hypophosphatemia), alcoholic ketoacidosis, osteoporosis

NM: Wernicke’s ,

Korsakoff

, cerebellar degeneration, peripheral neuropathy, seizures, Gout

Moderate amounts: reduce the risk of heart dx, DM2, dementia,

How much alcohol is too much alcohol?

Almost 50% of adults report drinking in the last year, 23% report binging in one occasion or more in the last month, 6% heavy drink use binging x5 in the last month

Binge drink >= 5 drinks at one day

Unhealthy use of alcohol: alcohol misuse, problem drinking, at-risk drinking ..

etc

Drinks limit for a healthy person by NIAAA:

Alcoholism

Def by

American Society of Addiction

Medicine:

primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and

manifestations, characterized

by impaired control over drinking, preoccupation with the drug alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may

be

continuous or

periodic

DSM IV: alcohol abuse, alcohol dependence

DSM V: Substance abuse disorder (Mild = abuse, Moderate to severe = dependence or alcoholism)

DSM V criteria of substance abuse disorder

Screening tools for dependence

AUDIT

CAGE

10 Items

4 items

Every question has different

score

Eye

opener test is the most specific

Detect

unhealthy alcohol use and alcoholism

Detect moderate to sever

e (dependence)

>8 means alcohol problem

>2 means a problem

AUDIT - C

Only the first 3 items of AUDIT , which deals with quantity and pattern

As sensitive and specific as the full AUDIT

A score of >= 3 , sensitivity of 98% for heavy drinking, 90% of alcohol use disorder, but a specificity of 60%

CAGE

Positive if >=2 , if = 1 needs further evaluationSensitivity of 74%, specificity of 91%

Cut down question is the most sensitive, but Eye opener is the most specific

Additional question of asking when was the last time you had X number of drinks, if the answer was within the last month, increase the specificity

Counseling

Studies showed brief counseling effective in a 4 year span

3 components: Feedback, advice and goal setting

The goal is to limit and not to stop drinking, except for alcoholics

Moderate to severe needs more counseling

Start by confronting the patient -> initial response is denial

Alcohol withdrawal syndrome

/Detoxification

If mild to moderate symptoms => out pt

settings

If severe =>

inpt

setting

Who will develop DTs and need

inpt

detox?

- moderate to severe withdrawal

- previous DT or seizure

- inability to cooperate with daily follow up

- comorbid medical or psych

Dx

that requires hospitalization

- inability to take meds by mouth due to nausea or vomiting

- unsuccessful previous outpatient detox

//TT of withdrawal

BDZ first line, barbiturate can be used as well

Most patients will need 3 days of TT, some will need weeks

No evidence of superiority of one BDZ over the other

//

cont’

Fixed dose

vs

PRN : showed no superiority in mild to moderate symptoms, no max dose

Even with the fixed doses you still have to asses the patient and give extra PRN doses

Relapse preventing

AA meeting , psychotherapy (cognitive behavioral), residential treatment

Pharmacotherapy : Adjacent to the ones above

-

Disulfiram

: needs supervised setting, no effectiveness on the long run, hepatotoxic

- Naltrexone (opioid-antagonist) : modest reduction, no significance

= injectable form (

vivitrol

): reduce heavy drinking days, modest effect, no need for abstinence from alcohol to begin with it, can’t use w/ opioid dependent patients

-

Acamprosate

(GABA analogue) : alone or w/ naltrexone, abstinence required

-

Topiramate

: not FDA approved, under study, could be use in

abstinenece

or w/o

Questions?