This document discusses alcohol use disorders and their treatment. It defines key terms like acute intoxication, withdrawal state, and dependence syndrome. It describes the major symptoms of alcohol withdrawal. It also outlines chronic health complications of alcohol use like Wernicke's encephalopathy and Korsakoff's psychosis. The document lists screening tools and treatments for alcohol dependence, including detoxification with benzodiazepines, vitamin supplementation, and approaches like psychotherapy, group therapy, and medications to reduce cravings or deter drinking.

1. ALCOHOL USE DISORDERS
VYJAYANTHI KADAMBI
INTERN
MMCRI

2. A drug is defined (by WHO) as any substance that,
when taken into the living organism, may modify one
or more of its functions. This definition conceptualises
‘drug’ in a very broad way, including not only
the medications but also the other pharmacologically
active substances.

3.  A psychoactive drug is one that is capable of altering the mental functioning.
 1. Acute intoxication,
 2. Withdrawal state,
 3. Dependence syndrome, and
 4. Harmful use.

4. Acute Intoxication
 Acute intoxication is a transient condition following the administration of alcohol
or other psycho active substance, resulting in disturbances in level of
consciousness, cognition, perception, affect or behaviour, or other
psychophysiological functions and responses. This is usually associated with high
blood levels of the drug.

5. Withdrawal State
A withdrawal state is characterised by a cluster of symptoms, often specific to the drug
used, which develop on total or partial withdrawal of a drug, usually after repeated
and/or high-dose use. This, too, is a short-lasting syndrome with usual duration of few
hours to few days.

6. Dependence Syndrome
 cluster of physiological, behavioural, and cognitive phenomena in which the use of
a substance or a class of substances takes on a much higher priority for a given
individual than other behaviours that once had greater value
 at least three of the following have been experienced or exhibited at sometime
during the previous year
1. desire or sense of compulsion
2. Difficulties in controlling
3. withdrawal state
4. Tolerance
5. Progressive neglect of alternative pleasures or interests
6. Persisting with substance use despite clear evidence of overtly harmful
consequences

7.  The major dependence producing drugs are:
1. Alcohol
2. Opioids, e.g. opium, heroin
3. Cannabinoids, e.g. cannabis
4. Cocaine
5. Amphetamine and other sympathomimetics
6. Hallucinogens, e.g. LSD, phencyclidine (PCP)
7. Sedatives and hypnotics, e.g. barbiturates
8. Inhalants, e.g. volatile solvents
9. Nicotine, and
10. Other stimulants (e.g. caffeine).

8. ALCOHOL USE DISORDERS
 Jellinek – Patterns of drinking
 ALPHA BETA GAMMA DELTA EPSILON
 Spree drinking or dipsomania
 Cloninger classification – Type 1 and Type 2
 late second or early third decade
 Males
 Insidious onset
 If the onset occurs late in life, especially after 40 years of age, an underlying mood
disorder should be looked for

10. In DSM- 5, the previous categories of ‘alcohol abuse’ and ‘alcohol dependence’ used
by DSM were integrated into a single ‘alcohol use disorder’ (AUD) with mild, moderate,
and severe subclassifications. Anyone meeting two of the 11 criteria in a 12- month
period receives a diagnosis of AUD; the severity grading is based on the number of
criteria met

11.  Single screening question for unhealthy alcohol use
• How many times in the past year have you had five (four for women)
or more drinks in a day?
• The question may be preceded by ‘Do you sometimes drink beer,
wine or other alcoholic beverages?’
• A response of one or greater indicates unhealthy use.
• Note: different thresholds are sometimes used for the number of
drinks, depending on standard drink size and national guidelines.

13. Lab Markers
 GGT
 CDT
 AST ALT ALP
 MCV
 URIC ACID
 BLOOD TRIGLYCERIDES

14. SCREENING TESTS
 CAGE QUESTIONAIRE
 AUDIT
 MAST

15. Acute alcohol intoxication

16. Withdrawal syndrome
 Hangover – most common
 Tremors – next
 Nausea and vomiting
 weakness, irritability, insomnia and anxiety
 delirium tremens, alcoholic seizures and alcoholic hallucinosis.

17. CHRONIC COMPLICATIONS
 WERNICKE’S ENCEPHALOPATHY
 KORSAKOFF PSYCHOSIS
 MACHIAFAVA- BIGNAMI DISEASE

18.  Other Complications
 These include:
 i. Alcoholic dementia.
 ii. Cerebellar degeneration.
 iii. Peripheral neuropathy.
 iv. Central pontine myelinosis.

19.  Gastrointestinal System
i. Fatty liver, cirrhosis of liver, hepatitis, liver cell
carcinoma, liver failure
ii. Gastritis, reflux esophagitis, esophageal varices,
Mallory-Weiss syndrome, achlorhydria, peptic
ulcer, carcinoma stomach and esophagus
iii. Malabsorption syndrome, protein-losing enteropathy
iv. Pancreatitis: acute, chronic, and relapsing

20. Central Nervous System
i. Peripheral neuropathy
ii. Delirium tremens
iii. Rum fits (Alcohol withdrawal seizures)
iv. Alcoholic hallucinosis
v. Alcoholic jealousy
vi. Wernicke-Korsakoff psychosis
vii. Marchiafava-Bignami disease
viii. Alcoholic dementia
ix. Suicide
x. Cerebellar degeneration
xi. Central pontine myelinosis
xii. Head injury and fractures.

21.  Miscellaneous
i. Acne rosacea, palmar erythema, rhinophyma, spider naevi, ascitis, parotid
enlargement
ii. Foetal alcohol syndrome (craniofacial anomalies, growth retardation, major organ
system malformations)
iii. Alcoholic hypoglycaemia and ketoacidosis
iv. Cardiomyopathy, cardiac beri-beri
v. Alcoholic myopathy
vi. Anaemia, thrombocytopenia, Vitamin K factor deficiency, haemolytic anaemia
vii. Accidental hypothermia
viii. Pseudo-Cushing’s syndrome, hypogonadism, gynaecomastia (in men),
amenorrhoea, infertility, decreased testosterone and increased LH levels
ix. Risk for coronary artery disease
x. Malnutrition, pellagra
xi. Decreased immune function and proneness to
infections such as tuberculosis
xii. Sexual dysfunction

22.  Social Complications
i. Accidents
ii. Marital disharmony
iii. Divorce
iv. Occupational problems, with loss of productive man-hours
v. Increased incidence of drug dependence
vi. Criminality
vii. Financial difficulties.

25. TREATMENT
i. Ruling out (or diagnosing) any physical disorder.
ii. Ruling out (or diagnosing) any psychiatric disorder and/or co-morbid substance use
disorder.
iii. Assessment of motivation for treatment.
iv. Assessment of social support system.
v. Assessment of personality characteristics of the patient.
vi. Assessment of current and past social, interpersonal and occupational functioning.

26.  The treatment can be broadly divided into two categories which are often
interlinked.
These are
 detoxification and
 treatment of alcohol dependence

27.  Detoxification is the treatment of alcohol withdrawal symptoms, i.e. symptoms
produced by the removal of the ‘toxin’ (alcohol).
 The best way to stop alcohol (or any other drug of dependence) is to stop it
suddenly
 The usual duration of uncomplicated withdrawal syndrome is 7-14 days. The aim of
detoxification is symptomatic management of emergent withdrawal symptoms.
 The drugs of choice for detoxification are usually benzodiazepines.
Chlordiazepoxide (80-200 mg/day in divided doses) and diazepam (40-80 mg/day
in divided doses) are the most frequently used benzodiazepines.

28.  preparation of vitamin B containing 100 mg of thiamine (vitamin B1) should be
administered parenterally, twice everyday for 3-5 days. This should be followed by
oral administration of vitamin B1 for at least 6 months.
 Care of hydration is another important step; it is extremely important not to
administer 5% dextrose (or any carbohydrate) in delirium tremens (or even in
uncomplicated alcohol withdrawal syndrome) without thiamine.

29.  Always give thiamine parenterally before the administration of glucose solutions
where there is a suspicion of chronic heavy alcohol use, to avoid precipitating
Wernicke’s encephalopathy.

30. Treatment of Alcohol Dependence
 Behaviour therapy- Aversion therapy
 Psychotherapy
 Group therapy- Alcoholics Anonymous (AA)
 Deterrent agents- Disulfiram 250-500 mg/day
 Other deterrent agents
1. Citrated calcium carbimide
2. Metronidazole.
 Anti-craving agents- Acamprosate, Naltrexone
 Psychosocial rehabilitation

32. THANK YOU