Alcohol Related Disorders


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Alcohol Use Disorders

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Alcohol Related Disorders

  1. 1. Introduction • Alcoholism is defined as alcohol seeking and consumption behavior that is harmful. • Long-term and uncontrollable harmful consumption can cause alcohol-related disorders that include: antisocial personality disorder, mood disorders (bipolar and major depression) and anxiety disorders.
  2. 2. Description • The hallmarks of this disorder are addiction to alcohol, inability to stop drinking, and repeated interpersonal, school- or work-related problems that can be directly attributed to the use of alcohol. • Alcohol-related disorders can affect the person’s metabolism, gastrointestinal tract, nervous system, bone marrow and can cause endocrine (hormone) problems. • Additionally, alcoholism can result in nutritional deficiencies. • Vitamin deficiencies, alterations in sugar and fat levels in • blood, hepatitis, fatty liver, cirrhosis, esophagitis, gastritis, dementia, abnormal heart rates and rhythms, lowered platelets, leukopenia.
  3. 3. Cloninger’s Alcoholism Typology Type I Late onset Rapid development of behavioral tolerance Mood issues: Prominent guilt and anxiety about drinking Personality traits: – High reward – dependence – High harm avoidance – Low novelty seeking Type II Early onset Not specified Mood issues: Absence of guilt and anxiety about drinking Personality traits: – Low reward dependence – Low harm avoidance – High novelty seeking
  4. 4. Causes • Alcoholism is a complex, multifaceted disorder • Behavioral – Related to the internal feedback: shame or hangover – External feedback: reprimands, criticism, or encouragement • Other external factors: peer pressure, acceptance in a peer group • Specific moods (easygoing, relaxed, calm, sociable) that are related to the formation of intimate relationships.
  5. 5. • Environmental factors: – Severe childhood trauma – Lack of peer and family support • Biological factors: – Repeated use of alcohol can impair the brain levels of a “pleasure” neurotransmitter called dopamine. – Norepinephrine - modulate reward dependence or the resistance to extinction of previously rewarded behavior – A high testosterone concentration during pregnancy may be a risk factor for the ADS in future
  6. 6. • Genetic factors: – Alcoholism recognized to be run in the family – 7 fold risk of alcoholism in first-degree relatives of alcohol-dependent individuals predominantly among males. – Twin studies & adoption studies- evident to the genetic vulnerability of the alcohol dependency – Type 2 alcoholism is more male limited type
  7. 7. Demographics • The lifetime prevalence in the general population for alcoholism is between 9.4% and 14.1% • Twice more among males (11.9:1.7- In india) • 20% among general hospital inpatients • Can develop among any caste irrespective of the socio-economic status • Urban Vs Rural: 5.8 & 7.3/1000 Overall: 6.9/1000.
  8. 8. Pathophysiology Alcohol has anesthetic & depressive property when taken as large dosage It causes euphoria when taken less This is caused by activation of mesolimbic dopaminergic circuit, particularly the ventral tegmental area (VTA) and the nucleus accumbens (NAc) by the alcohol. Anxiolysis and relaxation appear to be mediated by activation of the GABAergic neurotransmitter system (rewarding effect)
  9. 9. Clinical features • Alcohol dependence: – Compulsive drinking till the level of intoxication (S. Ethanol:50 to 150 mg/dl of blood) – Intoxication will be euphoria at first. – A/c intoxication- impaired thinking, in coordination, slow or irregular eye movements, and impaired vision. – A level of tolerance with chronic drinks. – Alcohol blackouts: amnesia with the presence of consciousness
  10. 10. • Alcohol withdrawal state: –disordered perceptions, seizures, tremor (often accompanied by irritability, nausea, and vomiting). Tremor of the hands called “morning shakes,” usually occurs in the morning due to overnight abstinence –Delirium tremens: 15% of alcohol dependent cases. (agitation, disorientation, insomnia, hallucinations, delusions, intense sweating, fever, and increased & tachycardia)- Medical emergency.
  11. 11. Assessment • DSM IV/ ICD 10 diagnostic criteria • Based on medical and (or) psychological conditions related to the alcoholism • Psychological diagnosis can be established using standardized tools such as; – CAGE questionnaire(Ewing, 1984), – MAST (Brief: 10 items; Short: 15 items & Self- Administered Alcohol Screening Test – SAAST: 35 items)- Selzer (1971) – AUDIT: 10-items. – Other psychological test for depression (BDI-II)
  12. 12. Psychiatric co-morbidity • 36.6% of those with a lifetime alcohol use disorder have at least one other psychiatric diagnosis (Regier et al.,1990) • Women diagnosed with AUD are more (72%) risk than males (57%) • Prevalence of illness was more with alcohol dependency than abuse. • The most frequent co-occurring diagnoses are for other drug use disorders, conduct disorder, antisocial personality disorder (more among men), anxiety disorders and affective disorders (more among women)
  13. 13. age of onset, severity of alcohol dependence and comorbid psychiatric disorders Course & natural history heavy drinking during the late twenties interference with functioning in multiple life areas during their early thirties loss of control, followed by an intensification of social and work-related problems, and onset of medical consequences in the mid- to late thirties severe long-term consequen ces by the late thirties and early forties (Schuckit et al.1993)
  14. 14. Goals of Alcoholism Treatment 1. Promote complete abstinence from alcohol. 2. Stabilize acute medical (including alcohol withdrawal) and psychiatric conditions, as needed. 3. Increase motivation for recovery. 4. Initiate treatment for chronic medical and psychiatric conditions, as needed. 5. Assist the patient in locating suitable housing (e.g., moving from a setting in which drinking is widespread), as needed. • Continues…
  15. 15. 6. Enlist social support for recovery (e.g., introduce to 12-step programs and, when possible, help the patient to repair damaged marital and other family relationships). 7. Enhance coping and relapse prevention skills (including social skills, identification and avoidance of high-risk situations). 8. Improve occupational functioning. 9. Promote maintenance of recovery through ongoing 10.participation in structured treatment or self-help groups.
  16. 16. Identification & management of alcoholism Initial assessment Diagnostic evaluation and treatment Intervention (AUDIT 16-40) Brief intervention and periodic reevaluation AUDIT 8-15) No intervention Needed (AUDIT <8) Evaluate presence and severity of physical dependence
  17. 17. Management of alcohol withdrawal • Through detoxification – Objectives: 1. Relief of discomfort, 2. Prevention or treatment of complications, & 3. Preparation for rehabilitation. – Careful screening for concurrent medical problems – Administration of thiamine (50–100 mg by mouth or IM) and multivitamins: prophylaxis for alcohol- related neurological disturbances.
  18. 18. • Social detoxification: Frequent reassurance, Reality orientation, monitoring of vital signs, personal attention & general nursing care • The commonly used drugs for the Rx of alcohol withdrawal are Benzodiazepines, diazepam and chlordiazepoxide (Hepatic side effects)
  19. 19. Non pharmacological measures • Cognitive and behavior therapies: – Relapse prevention, – Social skills and assertiveness training, – Contingency management, – Deep muscle relaxation, – Self-control training and – Cognitive restructuring – MET • Teach more adaptive coping strategies alter to the conditions that precipitate and reinforce drinking • Self help groups (AA)
  20. 20. Pharmacological management • Alcohol-sensitizing Drugs: –Disulfiram (125 to 500 mg ): disulfiram- ethanol reaction (DER) • Common S/e: drowsiness, lethargy and fatigue • Rare S/e: optic neuritis, peripheral neuropathy and hepatotoxicity.
  21. 21. Drugs that May Directly Reduce Alcohol Consumption 1. Opioid Antagonists 2. Serotonergic Medications 3. Acamprosate
  22. 22. Nursing care of patient with alcohol related disorders
  23. 23. Comparison between ICD 10 with DSM IV ICD 10 • flushed face and conjunctival injection for the Sx of alcohol intoxication • Alcohol Withdrawal require three symptoms from a list of 10 which includes headache DSM IV • impairment in attention for the Sx of alcohol intoxication