Psych - Alcohol Dependence

Front 1

Substance dependence DMS IV

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Maladaptive pattern of substance abuse leading to clinically significant impairment or distress manifested by 3 or more of the following within a year:

1. Tolerance - needing more of the substance to get the same effect or less effect with the same dose.

2. Withdrawal - Characteristic withdrawal sxs for that substance or the same/closely related substance is taken to relieve/avoid withdrawal sx.

3. Substance taken in larger amts over longer period of time than intended.

4. Persistent desire or unsuccessful efforts to cut down or control substance use.

5. Lots of time spent dealing with it (obtaining, using, recovering)

6. Important activities given up for it.

7. Continued use despite knowledge of having a persistent/recurrent physical or psych problem that will likely have been caused by or exacerbated by the substance.

Front 2

Alcoholism common in...

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men and native americans

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African americans..

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suffer more severe consequences from alcohol (but they abstain more)

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Alcohol and organs

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No other substance affects more organs with prolonged use.

Front 5

Cocaine

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Most likely to cause major physical problems with ACUTE use.

Cardiac arrythmias/death, strokes, seizures.

Front 6

Alcohol on GI system.

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Liver - Fat, alcoholic hepatitis, cirrhosis.
These can lead to death by liver failure, bleeding due to esophageal varices and decreased ability to form a clot.

CA of mouth, larynx, esoph. (Upper GI in general)

Gastric irritation/gastritis, reflux esophagitis, pancreatitis, diarrhea.

Front 7

Alcohol on CV system

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HTN

Cardiac arrythmias

Cardiomyopathy

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Alcohol on reproductive system

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Decreased sexual performance, sperm abnormalities, hypogonadism (liver damage can lead to increased estrogen levels).

Fetal alcohol syndrome in pregnant women.

Front 9

Characteristics of a child with FAS

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Small head, epicanthal folds, flat midface, smooth philtrum, low nasal bridge, small eye opening, short nose, thin upper lip, underdeveloped jaw.

Front 10

Alcohol effects on hematopoetic system

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Toxic effects on BM leading to abnormally large RBCs, poor reponse to infection, thrombocytopenia, anemia (secondary to nutritional deficiencies).

Front 11

Alcohol effects on dermatologic system

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Facial edema, redness

Worsening of conditions such as psoriasis.

Front 12

Alcohol effects of musculoskeletal system

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Aseptic necrosis of the femoral head (infarcts the head of the tumor--needs hip replacement)

Osteopenia (decalcification of bone) - more susc. to fractures.

Limb compression syndome - results from ischemia of soft tissue following prolonged pressure in a position assumed by a severely intox. individual.

Injuries/fractures

Front 13

Alcohol effects on CNS

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Peripheral neuropathy

Tx - nutrition, B vit supplements, active physical therapy to prev muscle shortening and sx such as foot drop.

Traumatic brain injury - 1/3 of pts hospitalized with head injury will be alcoholic.

Wernicke-Korsakoff syndrome - lack of dietary thiamine.

Wernicke's encephalopathy - Confusion, ataxia, ocular sx including paralysis of the eyes muscles and nystagmus. Level of consciousness is depressed--may go to stupor. Reversible with thiamine.

Korsakoff's psychosis - Amnesia and confabulation (reporting things that didn't happen - not reversible).

Front 14

Social and economic effects of etoh

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Most of any substance.

Front 15

Early sx of alcohol abuse

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Behavioral sx.

No physical/lab test findings, aside from urine, breath, blood alcohol tests.

Front 16

Best quantitative data obtained when...

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asking about specific day

"what did you drink yesterday?"

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CAGE

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Have you ever felt you should cut down on drinking?

Ever felt annoyed/angry by someone criticizing your drinking?

Guilty?

Eye opener?

Front 18

Prochaska/Clemente stages

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Move pt from pre-contemplation to action and maintenance.

Front 19

Addicts - abstinence rate

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about 40-60%

this compares nicely to drug compliance with other major disease (diabetes, HTN, asthma)

Front 20

Factors that best predict alcoholism

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Genetics and ethnicity.

Front 21

Does addictive personality exist?

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Probably not.

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Factors predicting successful recovery

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Devel. of vital interest to replace drinking

Continuing presence of external reminders that drinking was and would again be painful

Presence of new intimate relationship (w/ someone not part of earlier drinking)

Presence of source of inspiration, hope, self-esteem.

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Nature vs. nurture

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Studies also show that being raised in the home of an alcoholic does not increase the risk for alcoholism above that predicted just by having an alcoholic biologic parent.

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High rates and low rates of alcoholism...

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native american, irish french

jewish, some asians.

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Drugs that may work for alcohol dependence

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Acamprosate, naltrexone, disulfiram.

Front 26

Do you give an alcoholic pt drugs they could potentially abuse?

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Yes!

Just monitor it carefully.

Front 27

"IMPORTANT TAKE HOME MESSAGES"

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Alcoholism is extremely prevalent in medical practice and affects almost all major organ systems with prolonged use.

Alcoholism is a treatable chronic disease with the same qualities and expectations as other chronic medical illnesses, i.e. exacerbations (relapses) and remissions.

Relapse and multiple attempts to gain abstinence should be expected. Multiple interventions and patience may be necessary for the patient to achieve success, or even partial success.

Abstinence, when it occurs, is extremely gratifying for patient, family and caregiver, but should not be the only criteria for success.

Harm reduction should be the goal.

Treatment works.