Alcohol Abuse, Dependency, And Unhealthy Use

Front 1

How do you define a "Drink" with beer or a wine cooler?

Back 1

12 oz of beer/wine coller = 1 drink

Front 2

How do you define a "Drink" of wine?

Back 2

5 oz of wine (standard glass) = 1 drink

Front 3

How doe you find a "drink" of distilled spirits?

Back 3

1.5 oz of distilled spirit (whisky) = 1 drink

Front 4

What is a shot?

Back 4

30 mL = 1 drink

Front 5

What is a "minature"?

Back 5

50 mL = 2 drinks

Front 6

What is a Half-pint?

Back 6

237 mL = 8-9 drinks

Front 7

What is a pint?

Back 7

473 mL = 16-18 drinks

Front 8

What is a "fifth"?

Back 8

757 L = 25-30 drinks

Front 9

What is a quart?

Back 9

946 mL = 31-37 mL

Front 10

What is a half-gallon?

Back 10

1892 mL = 62-73 drinks

Front 11

In the US and Canada what is the BAC associated with legal intoxication?

Back 11

0.08% (80 mg/dL)

Front 12

What willl 2 standard drinks increase the average person's BAC by?

Back 12

0.05% (50 mg/dL) --- i.e. 3 drinks would be needed to meet legal intoxication (0.08%) for the average person.

Front 13

How fast does the average person metabolize alcohol?

Back 13

0.01-0.015% per hour (10-15 mg/dL/h)

Front 14

How fast does the average abuser of alcohol metabolize alcohol?

Back 14

0.02-0.03% per hour (20-30 mg/dL/h)

Front 15

What is the median lethal concentration (LC50) for the non-alcohol-dependent population?

Back 15

450 mg/dL

Front 16

What are the 3 alcohol withdrawal clusters?

Back 16

1) Autonomic hyperactivity (peaks 24-48 hours)
2) Neuronal excitation (often appear 12-48 hours)
3) DTs (rare; 48-72 hours)

Front 17

Mortality is increased beyond what amount of drinks for men vs. women?

Back 17

Men - >3-4 drinks/day; Women - >2-3 drinks/day

Front 18

Above what number of drinks for men vs. women is considered "unhealthy" drinking on an occasion?

Back 18

Men - >4 drinks; Women - >3 drinks

Front 19

Primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is 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.

Back 19

Alcoholism or Alcohol Dependence

Front 20

DSMIV Criteria for Alcohol Dependence

Back 20

3/7 of the following over the last 12 months: (1) Tolerance, (2) Withdrawal, (3) Substance taken in larger amounts or over longer period than was intended, (4) Persistent desire or unsuccessful efforts to cut down or control use, (5) great deal of time is spent in activities to obtain or use the substance or recover from its effects, (6) important social, occupational, or recreational activities are given up or reduced because of the substance, (7) Substance use is continued despite deleterious effects on physical and psychological health

Front 21

A positive answer (for the previous three months) when asking this question had a sensitivity of 85% and specificity of 82% for hazardous or harmful drinking [Alcohol Alcohol. 2005 May-Jun;40(3):208-13.]

Back 21

"When was the last time you had X or more drinks in one day?" (X = 4 for women, 5 for men).

Front 22

What are the CAGE questions?

Back 22

C = CUT DOWN; A = ANNOYED; G = GUILTY; E = EYE OPENER

Front 23

This CAGE question was the most sensitive (63%) and seemed to perform the best over a variety of demographic subgroups, but had the lowest specificity (84%).

Back 23

Have you ever felt that you need to CUT DOWN on your alcohol use?

Front 24

This CAGE question is the most specific (95%), but is relatively insensitive (21%).

Back 24

Have you ever had an EYE OPENER to steady your nerves or get rid of a hangover?

Front 25

Brief counseling has been sown to reduce unhealthy alcohol use for up to how many years?

Back 25

4 years

Front 26

These patients require ongoing counseling over extended periods of time and brief counseling has not shown to be effective in them?

Back 26

Alcoholics (dependents)

Front 27

What are risk factors for developing Delirium Tremens?

Back 27

The strongest risk factor appears to be previous delirium tremens or other complications during alcohol withdrawal. Other risk factors include elevated blood pressure or pulse at presentation, older age and the presence of medical co-morbidities.

Front 28

Recommended indications of inpatient alcohol detox?

Back 28

1-Moderate to severe withdrawal;
2-Previous seizures or delirium tremens;
3-Inability to cooperate with daily follow up;
4-Comorbid medical or psychiatric illness that requires hospitalization;
5-Inability to take medications by mouth/persistent nausea and vomiting;
6-Unsuccessful previous attempts at outpatient detoxification

Front 29

The benzodiazepine is generally used in patients with severe liver disease when treating alcohol detox

Back 29

Lorazepam

Front 30

The mainstay of maintenance of sobriety that you should recommend to patients and is associated with improved outcomes

Back 30

Attendance at AA (and other self-help groups)

Front 31

This drug inhibits the metabolism of alcohol and results in a buildup of acetaldehyde when alcohol is consumed, leading to nausea, vomiting and flushing. Studies of alcoholics prescribed this agent have failed to show lasting benefit in preventing relapse or reducing consumption of alcohol. However, this drug may still have a useful role in the treatment of selected patients, particularly in settings where the administration of the medication can be supervised. This drug has been associated with hepatitis and liver failure and should not be used in patients with pre-existing chronic liver disease; it can also cause neuropathy when used over an extended period of time.

Back 31

Disulfiram (Antabuse)

Front 32

This drug is thought to attenuate craving for alcohol by blocking endogenous opioids. A number of short-term studies (generally limited to 12 weeks) have found modest reductions in alcohol consumption; however, the largest and longest study to date failed to demonstrate a significant benefit [N Engl J Med 2001; 345:1734-1739]. A recent 6-month trial of an injectable form of this drug reported significantly reduced heavy drinking days with the treatment, but the absolute effect was modest. Nevertheless, it is FDA-approved for the treatment of alcoholism and a Cochrane review of its use concluded that it "appears to be an effective and safe strategy in alcoholism treatment." Of note, patients do not have to be abstinent from alcohol to begin this treatment, but it cannot be used in those who have an active opioid dependence or need for opioids therapeutically.

Back 32

Naltrexone (Revia)

Front 33

An inhibitory neurotransmitter which is thought to modulate alcohol craving and withdrawal; these receptors are one potential target for treatment of alcoholism.

Back 33

Gamma aminobutyric acid (GABA)

Front 34

A GABA analogue and studies suggest that it may have modest benefits either alone or in combination with naltrexone. However, two multicenter trials failed to find a benefit. Nevertheless, a recent Cochrane review concluded that “[this drug] appears to be an effective and safe treatment strategy for supporting continuous abstinence after detoxification in alcohol dependent patients." The most common side effect is diarrhea. It is recommended that it patients achieve abstinence before it is used.

Back 34

Acamprosate (Campral)

Front 35

This drug has effects on GABA transmission. Two randomized-controlled study of this antiseizure medication have reported a significant reduction in alcohol consumption and increase in abstinence over a 12-14 week period. The subjects were not required to be abstinent or detoxified at the time of enrollment. Side effects were common with this drug and the long-term impact has not been studied. It is not FDA-approved for treatment of alcohol dependence.

Back 35

Topiramate (Topamax)

Front 36

This drug is a a GABA agonist. In this placebo-controlled trial, among 84 alcoholics with cirrhosis, those who received this drug were significantly more likely to achieve and maintain abstinence at 12 weeks (71 vs. 29%). However, a subsequent trial on subjects without cirrhosis failed to find a significant benefit. In contrast to topiramate, this drug appears to have few side effects. Like topiramate, it is not FDA-approved for treatment of alcohol dependence.

Back 36

Baclofen