- Alcohol use disorders, including dependence and abuse, affect about 13% of the world population. Alcohol causes around 3.8% of deaths worldwide and 4.5% of disability-adjusted life years.
- There is a causal relationship between alcohol consumption and over 60 types of diseases and injuries. Some cancers and injuries caused by alcohol account for 20-30% of cases worldwide.
- Diagnostic criteria for alcohol dependence include tolerance, withdrawal symptoms, inability to control use, and continuing use despite harms. Dependence is associated with changes in brain regions involved in reward and inhibition.
Alcoholism has became the one of the leading cause for kidney and liver diseases. In India alcoholism is the root cause of poverty, unemployment, domestic conflicts, occupational disputes and deaths all together. Several Indian studies have shown the increased risk of suicide due to alcohol dependency. Thus it has became the global cause for depletion of human species all way round. Awareness, prevention, promotion, restoration and maintenance of health should be held up as essential base to work on for diverting the substance use/abuse and misuse and directing towards the sober community norms step by step to reduce intoxication, dependency, tolerance, conditioned learning and addiction as a whole.
Drug addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.
Brain changes that occur over time with drug use challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. This is why drug addiction is also a relapsing disease.
Relapse is the return to drug use after an attempt to stop. Relapse indicates the need for more or different treatment.
Most drugs affect the brain's reward circuit by flooding it with the chemical messenger dopamine. This overstimulation of the reward circuit causes the intensely pleasurable "high" that leads people to take a drug again and again.
Are you drinking TOO much?
Alcohol is the most commonly used potentially addictive substance in our society. Alcohol is responsible for over half of the $267 million dollars of substance related hospital costs in Canada. Problematic alcohol use significantly impacts individuals, families, and our community, but many struggle to know if they have a problem and where to go for help.
Learn more: http://www.theroyal.ca/mental-health-centre/news-and-events/newsroom/13411/alcohol-how-much-is-too-much/
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Alcoholism has became the one of the leading cause for kidney and liver diseases. In India alcoholism is the root cause of poverty, unemployment, domestic conflicts, occupational disputes and deaths all together. Several Indian studies have shown the increased risk of suicide due to alcohol dependency. Thus it has became the global cause for depletion of human species all way round. Awareness, prevention, promotion, restoration and maintenance of health should be held up as essential base to work on for diverting the substance use/abuse and misuse and directing towards the sober community norms step by step to reduce intoxication, dependency, tolerance, conditioned learning and addiction as a whole.
Drug addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.
Brain changes that occur over time with drug use challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. This is why drug addiction is also a relapsing disease.
Relapse is the return to drug use after an attempt to stop. Relapse indicates the need for more or different treatment.
Most drugs affect the brain's reward circuit by flooding it with the chemical messenger dopamine. This overstimulation of the reward circuit causes the intensely pleasurable "high" that leads people to take a drug again and again.
Are you drinking TOO much?
Alcohol is the most commonly used potentially addictive substance in our society. Alcohol is responsible for over half of the $267 million dollars of substance related hospital costs in Canada. Problematic alcohol use significantly impacts individuals, families, and our community, but many struggle to know if they have a problem and where to go for help.
Learn more: http://www.theroyal.ca/mental-health-centre/news-and-events/newsroom/13411/alcohol-how-much-is-too-much/
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
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Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
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2. Epidemiology
• alcohol dependence or abuse is a problem of 13 % of the
world population
• worldwide alcohol causes 2.5 million of deaths (3.8 % of
total) and 69.4 million (4.5 % of total) of Disability-Adjusted
Life Years (DALYs).
• there is a causal relationship between alcohol consumption
and more than 60 types of disease and injury.
• alcohol is estimated to cause about 20-30% worldwide of
oesophageal cancer, liver cancer, cirrhosis of the liver,
homicide, epilepsy, and motor vehicle accidents.
• men are more exposed to alcoholism than women (3-4x) but
percentage of women with alcohol problems increases
4. 2009 - Per capita recorded alcohol consumption (litres of
pure alcohol) among adults (>=15 years)
Country Value
Albania 4,9
Norway 6,4
Sweden 6,6
Italy 8,0
Greece 9,2
Poland 9,5
Netherlands 9,5
Belgium 9,7
Spain 10,0
Finland 10,0
Switzerland 10,1
Romania 10,5
Bulgaria 10,9
Country Value
Slovakia 11,0
Russian Federation 11,0
Denmark 11,3
United Kingdom 11,5
Germany 11,7
Luxembourg 11,7
Portugal 12,2
Hungary 12,5
Lithuania 12,5
Austria 12,7
France 12,7
Ireland 13,4
Czech Republic 14,8
Estonia 16,2
(according to World Health Statistics 2010
containing WHO's annual compilation of data)
5. Country Value
Bangladesh 0,0
Yemen 0,0
Afghanistan <0,1
Pakistan <0,1
Iran <0,1
Iraq 0,2
Egypt 0,2
United Arab Emirates 0,3
Algeria 0,4
Jordan 0,4
India 0,6
Viet Nam 1,2
Turkey 1,3
Central African Republic 1,6
Kenya 1,9
Cambodia 2,0
Zambia 2,3
Israel 2.5
Bolivia 2,8
Peru 3,1
Country Value
Zimbabwe 3,8
Ecuador 4,1
China 4,4
Cuba 4,5
Cameroon 4,7
Mexico 5,1
Brazil 6,2
Belize 5,8
Chile 6,8
Venezuela 6,9
Rwanda 7,0
Canada 7,8
Argentina 7,8
Japan 8,0
United States of America 8,5
New Zealand 9.3
Australia 9,9
Armenia 11,5
Republic of Korea 11,8
6. DSM – IV – ALCOHOL RELATED
DISORDERS
• Alcohol use disorders:
• abuse
• dependence
• intoxication …and complications
• withdrawal
• induced disorders
7. Diagnostic Classification
Abuse
– Maladaptive pattern of use for 12 months
causing social, role, or legal problems
Dependence
– Maladaptive pattern of use for 12 months with
specific symptoms of dependence
8. Diagnostic criteria of alcohol dependence.
ICD –10
1. A craving or feeling of compulsion to use the
alcohol
2. Evident impairment of the ability to control use of
alcohol. This can be related to difficulties in
avoiding initial use, difficulties in discontinuing
use, difficulties in controlling the level of use
3. Withdrawal state, or use of the substance to
mitigate or avoid withdrawal symptoms, and
subjective awareness of the efficacy of this
behaviour
4. Presence of tolerance to the alcohol’s effects
5. Progressive neglect of pleasures, behaviours or
interests in favour of using alcohol
6. Persistent use of alcohol despite evident presence
of harmful consequences.
9. Diagnostic criteria of alcohol dependence
DSM - IV
1. Tolerance defined as: need of considerably higher doses of the
alcohol to achieve intoxication or the desired effect or a
considerably diminished effect with continuous use of the same
quantity of the alcohol.
2. Withdrawal defined as: the characteristic withdrawal syndrome for
the alcohol or the same substance (or a closely related one) being
taken to reduce or mitigate withdrawal symptoms
3. The alcohol is often taken in higher quantities or for longer periods
than expected by the subject
4. Persistent craving or unsuccessful attempts to reduce or
control use of the alcohol
5. Considerable time is spent in activities needed to obtain the
alcohol, to take it or to recover from its effects
6. Discontinuation or reduction of major social, working or
recreational activities because of the use of alcohol
7. Continuous use of the alcohol despite the awareness of having a
persistent or recurrent problem of a physical or psychological
nature or a problem which is exacerbated by the substance
10. craving / compulsion
ICD - 10 DSM – IV
• impairment of the ability to
control use
• neglect of pleasures,
behaviours or interests in
favour of using alcohol
• use of alcohol despite
evident presence of
harmful consequences.
• unsuccessful attempts to
reduce or control use
• considerable time is spent on
activities needed to obtain
alcohol (discontinuation or
reduction of major activities)
• despite the awareness of
having a persistent or
recurrent problem
withdrawal
tolerance
11. ICD 10
PROBLEM DRINKING DEPENDENCE
F10.1 F.10.2
Health and social
negative consequences
Health and social
negative consequences
+
diagnostic criteria
(≥3)
13. CAGE
• craving During the last 3 months, have you
ever thought you should drink less alcohol?
• anger During the last 3 months, have you
ever got upset because somebody told you
to drink less?
• During the last 3 months, have you ever
felt guilty because you drunk too much?
• eye-opener During the last 3 months, have
you ever waken-up in the morning with a
wish for an alcoholic drink?
14. MAST
Michigan alcohol Screening Test
22 (or 25) item questionnaire to screen
for lifetime alcohol related problems
and alcoholism.
scores indicate:
0 - 2 No apparent problem
3 - 5 Early or middle problem drinker
6 or more Problem drinker
15. The role of amygdala
• The central amygdala, a part of the brain involved
in emotions such as stress and fear, sending
impulses to the ventral tegmental area, locus
coeruleus, and laterodorsal tegmental nucleus for
activation of dopamine, norepinephrine and
epinephrine.
• is important in regulating alcohol consumption.
• Most central amygdala neurons communicate via a
chemical signal known as GABA (an inhibitory
neurotransmitter).
• Alcohol dependence has been associated with the
strengthening of inhibitory synapses in this brain
region.
16.
17. Etiology
• The environmental factors
• The genetic factors
• The neuromediator systems
· the norepinephrin system
· the dopaminergic system
· the serotoninergic system
· the cholinergic system
· the GABAergic system
· the opioidergic system
18. The incentive phase
• Dopamine is commonly associated with the
pleasure system of the brain, providing
feelings of enjoyment and reinforcement
to motivate a person to perform certain
activities. Dopamine is released
(particularly in areas such as the nucleus
accumbens and prefrontal cortex) by
naturally rewarding experiences such as
food, sex, or alcohol.
• dopamine is more associated with
anticipatory desire and motivation
("wanting")
• these dopamine pathways are pathologically
altered in addicted persons
20. The consumatory phase
Consummatory pleasure (commonly referred
to as "liking„)
• In the contemporary view, the trend is to
acknowledge the possibility that the
hypothalamus creates peptides in the brain
that equal and/or exceed the effect of
externally applied chemicals (alcohol,
nicotine etc.) when addictive activities take
place.
• when an addict is satisfying his craving,
endorphins are produced and released
within the brain, reinforcing the
individual's positive associations with their
behavior.
22. Etiology
The biochemical factors:
Alcohol is metabolized by two enzymes:
alcohol dehydrogenase (ADH) - catalyses
the conversion of alcohol into acetaldehyde
which is the toxic compound,
aldehyde dehydrogenase - catalyses the
conversion acetaldehyde into acetic acid.
aldehyde dehydrogenase is inhibited by
disulfiram (Antabuse )
24. DIAGNOSTIC CRITERIA FOR ALCOHOL
INTOXICATION (DSM IV)
A. recent ingestion of alcohol
B. clinically significant maladaptive behavior or psychological
changes (eg. inappropriate sexual or aggressive behavior,
mood liability, impaired judgment, impaired social or
occupational functioning) that develop during or shortly
after alcohol ingestion
C. one or more of following signs developing during or shortly
after alcohol ingestion:
• (1) slurred speech
• (2) in-coordination
• (3) unsteady gait
• (4) nystagmus
• (5) impairment in attention or memory
• (6) stupor or coma
The symptoms are not due to a general medical condition and
not better accounted for by other mental disorder.
25. Clinical symptoms of acute intoxication
Concentration
of ethanol
(promille):
The disorganised
function of the
central nervous
system:
The effects of an ethanol
action:
0,2 –0,5 Self-criticism
Intellect
Handicap higher acts of brain,
improvement of frame of mind,
carelessness, diminution of moral
brakes, diminution of criticism,
decrease of cognitive functions
0,5-1,5
Sensorial,
emotional, motorial
control
Shaky walk, mumbling speech,
considerable diminution of motorial
efficiency, lack of emotional self-
control
1,5-3,0 Consciousness,
orientation
Sopor, stupor
3-5 Alcohol coma
>5 Death
26. The treatment of
the acute intoxication
• Estimation of the patient state
• Drug treatment as a help only
No benzodiazepins !
No neuroleptics !
• Vitamines (B1,B12, acidum folicum)
• 1-2 l 0,9 % NaCl and 10 % glucose + 15 u.
insulin + 100-200 mg tiamine - to improve
alcohol metabolism
• In stupor or coma a routine treatment is
practiced ( as with other substances
working depresivly on the central nervous
system).
27. Alcohol withdrawal („the shakes”)
A. Cessation of (or reduction in) alcohol use that has been
heavy and prolonged
B. Symptoms developing within several hours to a few days :
• autonomic hyperactivity
• tachycardia or hypertension
• tremulousness (trembling of a tongue, eye-lids, and hands)
• diaphoresis
• sweating
• nausea or vomiting
• insomnia
• irritability
• anxiety
• psychomotor agitation
• headaches
• orthostatic hypotension
• malaise or weakness
• transitory hallucinations or illusions
• grand mal seizures
28. COMPLICATIONS
• Tremulousness (commonly called
shakes, jitters) develops 6 - 8 h
after the cessation of drinking
• Psychotic and perceptual symptoms
begin in 8 – 12 h
• Seizures in 12 - 24 h
• DT –during 72 h or first week of
withdrawal (symptomes usually develop on
the third day after withdrawal)
29. Delirium Tremens
• In addition to symptoms of delirium (consciousness
disturbances ) the symptomes of alcohol withdrawal
delirium include autonomic hyperactivity, tachycardia,
fever, insomnia, anxiety and hypertension, perceptual
distortions, visual or tactile hallucinations(formication),
fluctuating motor activity (from hyperexcitability to
lethargy)
• Is a medical emergency ( mortality rate of 20 %).
• Patients with DT are dangerous to themselves and to
others.
• unpredictable behavior - may act on hallucinations or
delusional thoughts
30. Treatment of DT
• Benzodiazepines
– to prevent: 25-50 mg every 2-4
– to treat DT: 50-100mg every 4
• Physically restraining is risky – they may fight to a complete
exhaustion
• Dehydration caused by diaphoresis and fever can be
corrected with fluids given by mouth or intravenously
• Antipsychotic medication should be avoided (may decrease
the seizures threshold)
31. Cause of death in DT:
• intercurrent somatic diseases,
like pneumonia, hepatic
insufficiency, heart failure,
• unpredictability of suicidal
behavior,
• fever, dehydration ect.
32. Alcohol withdrawal and
detoxification
• Withdrawal from large amounts can
cause mild to life threatening
symptoms lasting for days to weeks
• Requires medical monitoring and
treatment with medication to prevent
seizures and delirium tremens
33. The treatment of
withdrawal syndromes
• Exact patient’s examination
• Estimation of biochemical parameters
• Check of life parameters (every 6 hours) and
continuous observation as well
• Supplementation of electrolyte disturbances,
irrigating, treatment of comorbid disorders
• BZD administration ( diazepam, lorazepam). In
case of severe anxiety or psychotic symptoms
haloperidol is used
• Vitamins: tiamine, nicotinic acid
• Magnesium Sulphate might be administrated as
well
34. Long term effects of alcohol
Medical
• Polyneuropathy
• Cardiomiopathy
• Hypertension
• Skeletal muscle damage of
uncertain clinical
significance
• Gastritis, peptic ulcer
• Constipation
• Pancreatitis
• Cirrhosis
• Impotence
• Various anemia
• Accidents
Mental disorders
– Depressed or anxious
mood, especially during
withdrawal
– Decreased appetite,
poor sleep, body aches,
suicide attempts
– Disinhibited behavior
– Alcohol induced mental
disorders
35. Complications of alcoholism -
physical complications
LIVER:
• The major adverse effect of alcohol use are related to liver
damage.
• Heavy drinking can result in an accumulation of fats and
proteins leading to fatty liver.
• Alcohol use is associated with developing alcoholic hepatitis
and hepatic cirrhosis.
• Hepatic encephalopathy – hepatic dysfunctions cause
changes in intellectual and emotional processses as well as in
psychomotor and behavioral regulation
GASTROINTESTINAL SYSTEM:
• Alcohol abuse inhibit intestine’s capacity to absorb various
nutrients such as vitamins and amino acids. This effect
coupled with the often poor dietary habits can cause serious
vitamin deficiencies, particularly of the B-group vitamins.
36. Alcohol induced persisting dementia
- A result of Cerebral athrophy
It is difficult to separate the toxic
effects of alcohol abuse from the
CNS damage, done by poor nutrition,
or malfunctioning of such organs like
liver, pancreas, kidneys,
37. Alcohol induced persisting amnestic
disorder
Wernicke – Korsakoff Syndrome
Wernicke’s encephalopathy
• A set of acute symptoms,
completely reversible with
treatment ;
• Characterized by: ataxia
(specially the gait), vestibular
dysfunction, confusion, ocular
motility (horizontal nystagmus,
gaze palsy, sluggish reaction to
light).
• May clear spontaneously in a few
days or weeks or may progress
into Korsakoff’s syndrome.
Korsakoff’s syndrome
• Chronic amnestic syndrome
that can follow the Wernicke’s
encephalopathy.
• Features: impaired recent
memory and anterograde
amnesia in alert and
responsive patient.
• Confabulation may occur or
not.
Both caused by thiamine deficiency
Treatment: large doses of thiamine
38. Alcohol induced persisting amnestic
disorder, c.d.
Alcoholic pellagra encephalopathy
Nicotinic acid (niacin, vitamin B3) deficiency
encephalopathy
a patient, who seems to suffer from
Wernicke – Korsakoff’s syndrome but do
not respond to thiamine treatment.
Symptoms: confusion, clouding of
consciousness, myoclonus, fatigue, apathy,
irritability, anorexia, insomnia, sometimes
delirium.
39. Alcohol induced psychotic disorder
(with delusions )
• Usually in chronic alcohol abuse.
• Most common hallucinations are auditory, usually voices, but
often unstructured.
• Voices are maligning, reproachful, threatening, sometimes
pleasant.
• Impaired reality testing is common.
• Often last less then one week. After the episode most
patients realized the hallucinatory nature of those
symptoms.
• Differentiation criteria: the temporal association with
alcohol withdrawal, short time duration and absence of
history of schizophrenia; presence of the clear sensorium
differs from DT.
Treatment: benzodiazepines, good nutrition and fluids. In long
term cases antipsychotic drugs may be used.
40. Other alcohol induced disorders:
• Alcohol induced mood disorder
With manic, depressive or mixed features – onset
during either intoxication or withdrawal
• Alcohol induced anxiety disorder
Generalized anxiety, panic attacks, obsessive-
compulsive disorder.
(may be difficult to decide whether the anxiety
symptoms are secondary or primary)
• Alcohol induced sleep disorder
• Alcohol induced sexual dysfunction
41. Fetal alcohol syndrome (FAS)
Occurs when a fetus is
exposed to alcohol due to
it’s mother’s drinking.
• mental retardation,
• inhibited growth and
postnatal development
• microcephaly,
• facial malformations,
• limbs and heart defects
• maladaptive behavior
42. Complications of alcoholism
social complications
Alcoholic’s families problems
Unemployment
Crimes
• Functional problems
– Relationships
– Work
– Money
– Housing
– Legal
health and psychiatric
complications
• Suicide
• Depression
• Hallucinosis
• Dementia
• Othello’s syndrome
• Delirium tremens
44. Common consequences of use
Positive
• Friendships
• Sense of belonging
to a group
• Facilitation of
intimacy/sex
• Relief from distress
• Pleasure and
enjoyment
• Reduction of craving
or withdrawal
symptoms
Negative
• Relapse of
symptomes
• Interpersonal
conflicts
• Financial problems
• Health
• Housing problems
• Legal problems
• Institutionalization
– Hospital
– Jail
45. Three patterns of
chronic alcohol abuse
• Regular daily excessive drinking
• Regular heavy drinking on weekends
only
• Long periods of sobriety
interspersed with binges that last
days, weeks, or months
46. Phases of alcoholism
1. Social drinking
2. Warning phase
3. Phase of symptoms
4. Chronic phase
47. History of alcohol dependence
1. Begining of alcohol use and warning symptoms
a. the first contact with alcohol
b. the first intoxication
c. the first deep intoxication
- symptoms of phisical intolerance, e.g. vomiting
- better feeling, relaxation after alcohol intake
- social disaproval connected with alcohol abuse
- increase of alcohol tolerance
48. History of alcohol dependence
2. Problem drinking (phase of symptoms)
a. alcohol intakes lasting longer then one day
b. aggressive behavior after alcohol intake
c. social pressure towards abstinence
d. beginning of law problems
e. withdrawal symptoms
f. lonely alcohol intake
g. feeling of alcohol abuse
h. absence at work
i. troubles with employment
j. inability to decrease and discontinue drinking
49. History of alcohol dependence
3. Attempts to control drinking
a. trying to decrease amount of alcohol
b. drug self-administration to improve the
medical condition
c. Disulfiram, Esperal
d. feeling of alcohol dependence
History of alcohol dependence
50. History of alcohol dependence
4. Chronic phase
a. decrease of alcohol tolerance
b. anxiety, fear, distress
c. body trembling
d. the first visit at a psychiatrist
e. aversive drugs intake
f. dysfunctions of CNS or other physical complications
g. the first hospitalization
h. the first alcohol psychosis (delirium, hallucinosis)
51. assessment questions
– When do you usually drink?
– Who do you drink with? Where? When?
– What makes you feel like having a ___?
– What is it like when you drink? How do you
feel? What do you do?
– What do you enjoy about drinking?
– What are the down sides of drinking for you?
– What do other people think/say about your
drinking?
52. Common cues
• External
– People
– Places
– Activities
• Internal
– Thoughts
– Emotions
– Craving
54. Dependence treatment
• confrontation of denial
• insistence of abstinence
• assessment of motivation
• pharmacotherapy: Disulfiram, Naltrexone,
Acamprosate
• involvement of family
• Alcoholics Anonymous
• Cognitive -behavioral therapy
55. Dependence treatment
Modern programs of addiction psychotherapy are
based on the Minnesota program
• Engagement
– Outreach, practical help, crisis intervention, develop alliance,
assessment
• Persuasion
– Education, set goals, build awareness of problem (motivational
counseling), practical skills training, family support, peer support
• Active Treatment
– Substance abuse counseling, medication treatments, skills training,
self help, groups, family
• Relapse prevention
– Relapse prevention plan, continue skills building in active treatment,
expand recovery to other areas of life
– Different services are helpful at different stages of treatment
56. Groups of support
AA – is a voluntary supportive fellowship of persons
with alcohol related disorder
• AA is part of multiple- treatment approach.
• members make a public admission of their alcohol
related disorder and abstinence is the rule.
• was founded in 1935 by two alcohol addics: a stock
– broker and a surgeon
Al – Anon is an organization of spouse of people
with alcohol related disorders and is structured
along the same lines as AA.
• helps the spouse to regain the self – esteem
• to refrain from feeling responsible for a spouse
drinking
• to develop rewarding life for themselves and their
families