A summarized slide for alcohol use disorder and its management

1. Alcohol Misuse
Alcohol consumption associated with social, psychological and physical
problems

2. Few facts:
• About 90% of adult population drinks alcohol at some time.
• Alcohol is implicated in 40% of all RTA, 50% of murders and 80% of
suicides

3. Safe limits and its calculation
• 14 Units in a week for both men and women with 2 alcohol free days
(?) and not more than 3 Units in a day.
• 1 Units = Amount of alcohol that can be metabolized by an average
human body within 1 hour. I.e. 10ml/8g.
No. of Unit= % of alcohol ingested * amount ingested in ml/1000

4. Classification
• Alcohol Intoxication: slurred speech , impaired coordination and
judgement, labile affect, and in severe cases hypoglycemia, stupor and
coma, accidental injuries.
• Alcohol withdrawal : reflects the degree of previous dependence
• Alcohol dependence

5. Alcohol withdrawl
• Complicated and uncomplicated withdrawl

6. Alcohol dependence

7. Physical effects of Dependence

8. Psychiatric and cerebral Effects
• Depression: In majority depression resolves within 2 weeks of stopping drinking
• Suicide: depression and disinhibiting effect of alcohol, social problems and poor
physical health are responsible.
• Alcoholic hallucinosis: mostly auditory. Unlike schizophrenia, there are no
delusions, thought disorder and other first rank symptoms. Trt: antipsychotics
• Alcoholic dementia

9. Contd…
• Wernicke’s encephalopathy and korsakoff’s psychosis:
Thiamine deficiency is due to : no nutritional value of alcohol
worsened by decreased absorption and impaired storage.

10. Etiology

11. Assessment
• History and physical examination
• Mental state examination
• Screening questionnaire
• Liver function test, Complete blood count
And peripheral blood smear.

12. Treatment
Management of withdrawal and prevention of relapse
1. Management of withdrawal: Admit if complicated withdrawal/the person is
child or vulnerable.
Initially high sedation with benzodiazepine ( DOC: Chlordiazepoxide with rapid
tapering).
In delirium tremens : Lorazepam(DOC) or antipsychotics
Additional: rehydration, correction of electrolyte imbalance and hypoglycemia, oral
or parenteral thiamine.

13. Contd…..
2. Prevention of relapse
a. Disulfiram(200-400 mg daily): to resist the impulse. Patient must be
motivated to stop drinking and should have been alcohol free for at
least 24 hours. It causes accumulation of acetaldehyde leading to
unpleasant reaction with headache, flushing and nausea.
b. Acamprosate or naltrexone: reduces craving.
c. Residential rehabilitation programs.
d. Self help organizations.

14. Other substance abuse disorder.