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Alcohol Dependence
Behavioral Medicine
| Question | Answer |
|---|---|
| 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:
Abarnard
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