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Alcohol Dependence

Behavioral Medicine

spectrum of alcohol use abstinence, moderate drinking, at-risk drinking, abuse (problem drinking), dependence (addiction)
a pattern or level of alcohol use that is associated with increased risk of development of adverse physical psychological, or social consequences hazardous drinking
13.6 g alcohol in __ beer or wine cooler 12 ounces
13.6 g alcohol in __ wine 5 ounces
13.6 g alcohol in __ spirits (80 proof) 1.5 ounces
at risk drinking in men >14 drinks/week, >4 drinks per occasion
at risk drinking in women >7 drinks per week, >3 drinks per occasion
at risk drinking in persons over 65 years old >7 drinks per week
substance abuse (DSM-IV) must fulfill at least 1 of 4 criteria immediately hazardous to users or others (Risky), interferes with Role function, continues despite causing Relationship problems, results in recurrent legal problems (Run-ins with the law), and doesn't meet criteria for substance depencence
substance dependence (DSM-IV) must fulfill at least 3 out of 7 criteria unsuccessful efforts to quit or cut down, uses more than intended, continued use despite adverse physical or psychological consequences, excessive time devoted to obtaining/using/recovering, change in activities/relationships, tolerance, withdrawal
alcohol withdrawal onset __ hours after last drink 12-24
alcohol withdrawal peak intensity at __ hours after last drink 24-48
clinical features of alcohol withdrawal tremor, tachycardia, hypertension, sweating, insomnia, nausea/vomiting, photophobia, hallucinations, hyperreflexia, irritability, anxiety, alcohol craving, seizures possible
alcohol withdrawal delerium duration __ days 4-7
alcohol withdrawal delerium has a __% mortality 10-15
predictors of relapse non-adherence to meds/diet/behavior change, low SES, low family support, psychiatric co-morbidity
heavy drinking is associated with what cancers breast, liver, head/neck
__% of adult primary care patients are alcohol dependent 5
__% of adult primary care patients abuse alcohol 7
__% of adult primary care patients display at risk drinking behavior 8
__% of adult primary care patients drink alcohol in moderation 45
alcohol is implicated in __% of suicides 33
alcohol is implicated in __% of MVA deaths 40
alcohol is implicated in __% of domestic violence cases, homicides, and trauma center cases 50
alcohol abuse related clinical tasks prevent, recognize/diagnose/assess, brief intervention when appropriate, initial management (detox), refer, support
USPSTF recommends screening of all adolescents & adult pts for __ problems alcohol
mnemonic for alcohol abuse screening CAGE
what does CAGE stand for Cut down, Annoyed, Guilty, Eye-opener
score of 1+ on CAGE- warrants further investigation
score of 2+ on CAGE- highly suggestive of alcohol dependence
FRAMES for brief alcohol intervention stands for feedback, responsibility, advice, menu of options, express empathy, support self-efficacy
medications for alcohol dependance naltrexone, acamprosate, disulfiram
in the setting of alcohol withdrawal basing benzodiazepine dose on __ score allow more precise dosing CIWA (Clinical Institute Withdrawal Assessment)
medication that creates and adverse reaction to alcohol disulfiram
neurotransmitter enhanced by ethanol GABA-major inhibitory transmitter in brain
neurotransmitter suppressed by ethanol Glutamate-major excitatory transmitter
opioid antagonist that reduces relapse/cravings in recovering alcoholics naltrexone (revia)
effective psychosocial therapies for alcoholics cognitive behavioral therapy, motivational enhancement therapy, 12-step (AA), individual drug/alcohol counseling, brief intervention for problem drinkers
positive AUDIT score for men 60 or younger 8
positive AUDIT score for women 4
a positive AUDIT result does not constitute a __ diagnosis of alcoholism but does warrant further evaluation
if yes to one or more of the following questions it means that your patient meets criteria for alcohol abuse. in the past 12 months has your patient's drinking repeatedly caused or contributed to: RISK of bodily harm, RELATIONSHIP trouble, ROLE failure, RUN-INS with the law
if the answer to three or more of the following questions is yes then your patient has alcohol dependance. In the past 12 months, has your patient not been able to stick to limits. not been able to cut down or stop. Shown tolerance. Shown signs of withdrawal. Kept drinking despited problems. Spent a lot of time drinking. Spent less time on other matters
signs of withdrawal tremors, sweating, nausea, insomnia when trying to quit or cut down
questions to ask to assess for readiness for change what are your thoughts about your drinking? Do you have any concerns related to your drinking? How important is it for you to make a change in your drinking. How confident are you that you could successfully change if you wanted to?
intervention for moderate drinking reinforce, educate re: limits
intervention for at-risk and problem drinking brief alcohol intervention (BAI)
intervention for alcohol dependance advise abstinence, refer for treatment
what to do for the alcohol dependant patient recommend total abstinence, assess risk of acute withdrawal, assess psychiatric and medical comorbidity, refer for evaluation and treatment in a formal addiction treatment program, schedule follow-up to assess compliance
who do you recommend alcohol abstinence to pregnant/contemplating pregnancy, medical conditions made worse by alcohol, on meds that interact with alcohol, past/current dependence
Acute neuro disorder characterized by ataxia, vestibular dysfunction, ocular abnormalities, & confusion, caused by thiamine deficiency = Wernicke encephalopathy
Created by: Adam Barnard Adam Barnard