Pg aspect of alcohol use disorder

1. Shhhh..

2. Alcohol – Over view & Neurobiology
Dr.K. KRISHNAMURTHY
PROFESSOR & HEAD
DEPARTMENT OF PSYCHIATRY
NARAYANA MEDICAL COLLEGE
NELLORE-524 002

3. THE FASTEST
GROWING PUBLIC
HEALTH MENACE IN
THE WORLD IS NOT A
DISEASE BUT A
PRODUCT
(WORLD WATCH 1990)

4. Alcohol
 Agent That controls mind
 Most misused substance
 Alcohol related disorders up to 26% in G.P
 Consumes More than 15% of National Health budget
 50% Murders
 40% violent acts
 More than 30% rapes
 30% suicides
 On the fore front in Death, Imprisonment, Police cases,
Divorces, destruction of Families………….

5. Alcohol
 34-42% population reported to be using Alcohol in
their life time
 5-7% abuse Alcohol
 10-20 Million people are in need of Treatment
 1.2% 0f total Death,1.6% of the DALY in 1990(
Global burden report)
 Enormous impact on Economy and Public Safety

6. NFHS-3, 2005-06
(Percentage)

7. Alcohol….
 Increases Through Teens Peaks in 20s and then
slowly Declines
 2-3% 12 yr old
 70% 20-29 Yrs
 1/3 of age 65
 Males Drink More 5.5:1. ( Not significant at12-17
Yrs)
 22.8% aged 12 yrs and older – Binge Drinkers ( 5
or More in a single sitting)
 6.9% Heavy Alcohol Use

8. Actual consumption
5.11 million consumers in Karnataka state annually consume 100.87 million
litres absolute alcohol equivalent (56.53 million l. excise paid + 44.34 million l. undocumented).
Amounts to 20 litres AA/drinker/year = 62 bottles of whisky/drinker/year

9. Frequency of use of preferred beverage
(Past 3 months)
In Women
Frequency of use
less
1/month
2-3/month
1-2days/week
3-5 days/week
Daily
Percent
60
50
40
30
20
10
0
Frequency of drinking
occasions
Frequency of use of preferred beverage
(Past 3 months)
In Men
Frequency of use
less
1/month
2-3/month
1-2 days
3-5 days/week
Daily
Percent
70
60
50
40
30
20
10
0
More than 55% of female consumers and more than 68% of male consumers drank
their beverage of first preference, daily or almost daily
WHO Undoc Cons Study,
2003

10. Quantity per drinking occasion
No. of drinks - preferred beverage
22.5
20.0
17.5
15.0
12.5
10.0
7.5
5.0
2.5
0.0
No. of drinks - preferred beverage
In Women
Frequency
60
50
40
30
20
10
0
Std. Dev = 4.24
Mean = 4.9
N = 83.00
No. of drinks - preferred beverage
45.0
40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
No. of drinks - preferred beverage
In Men
1400
1200
1000
800
600
400
200
0
Std. Dev = 3.41
Mean = 4.9
N = 2110.00
4.9 (3.4) drinks per typical drinking occasion in men and 4.9 (4.2) drinks
in women !!!!!!!
Men drank 62.2 (43) ml. of absolute alcohol equivalent and women drank 62.3 (53.4) ml. of
absolute alcohol equivalent per typical drinking occasion
WHO Undocumented Consumption Study, 2003

11. GBD 2004: Population attributable fractions
(%) for mortality - risk factors
Low- and middle-income countries of the South-East Asia Region
The global burden of disease: 2004 update (2008) WHO, 2009
4 5
1
3
5
8
0
1
2
3
4
5
6
7
8
9
Tobacco use Alcohol use
Illicit drug
use BP
Water,
sanitation Underweight

12. Cultural
• Dry culture attitudes – stigmatizing, marginalizing, minimising
• Expectancies predisposing to hazardous patterns of use
Economic
• 2nd highest source of income for state governments
• Largest emerging market – rapid growth sector
Impact
• Rapid lowering of age at onset (early start greater AUDs)
• Greater impact in poorer populations
• Common risk factor for multiple NCDs and CDs
Response
• Unsuccessful attempts at prohibition
• Focus on tertiary level interventions; public health nature under-
recognised
Public health
crisis

13. 1

21.  41% who Exceed the recommended use of
intake daily meet Dependence Criteria
 16% Meet Criteria for Alcohol Abuse
 43% do not meet criteria for Abuse or
dependence

30. Recent reviews:current treatment systems
LMICs
 Where available, mainly oriented to tertiary treatment of dependence
- long-term residential treatment in rehabilitation centres,
specialised clinics, or psychiatric hospitals
 Concentrated in urban areas , often in private settings, usually with
high fee structures. Where govt-funded treatment centers available-
overall efficacy is low
 Large proportion remain untreated (median treatment gap 78.1%)
 First seek help for early problems from primary health care providers
who are not trained to recognise the problem . Those who are finally
treated often have to wait for over a decade before receiving
treatment for their alcohol misuse
 First addressed when already severe & difficult to treat, secondary
prevention in earlier stages of drinking problems virtually
nonexistent, and many heavy drinkers at risk of developing AUD in
future are not targeted by health interventions.
Perngparn et al(2008) Drug and alcohol services in middle-income countries. Curr Opin Psychiatry 21: 229–233.

31. Prioritizing resources
 Most alcohol-related harm is attributable to
hazardous/ harmful drinkers rather than to people
with alcohol dependence.
 This distinction is rarely made, especially in LMICs
where politicians, planners, and the public discourse
have focused primarily on alcohol dependence—the
conventional central motif of alcohol misuse.
 Concentrating on the rarer presentation of dependence
only serves to minimize the problem, stigmatize the
condition, and marginalize affected individuals.
Benegal et al (2009) Treatment of Alcohol Use Disorders in Low and
Middle Income Countries: Neglected Disorders. PLoS Medicine

32. ?
ANY
QUESTIONS?