Dr.Abdulrahman Othman MaroofSubstance(drug) abuse disorders-Part II

5th Stage – 17.05.2011Alcoholism

Alcoholism: a treatable disease. 1.Alcohol abuse: compulsive ,uncontrolled consumption of alcohol despite its negative effects on the drinker's health.2.Alcohol dependence = alcohol abuse + tolerance, physical dependence. Withdrawal symptoms, and an uncontrollable drive to drink.

Types of alcohol consumers:1.Alpha-Drinker: conflict, no loss of control.2.Beta-: Drinker: social occasions .3.Gamma- Drinker: Loss of control, still able to abstinence.4. Delta-Drinker: daily regular drinking, alcohol, no ability to abstinence.5.Epsilon Drinker: episodic drinking by affective disorders like mania depression.

Long term damage: Physical:Cirrhosis , pancreatitis,,

polyneuropathy, alcoholic dementia,

Cardiomyopathy, Trauma, nutritional deficiencies,

sexual dysfunction, malabsorption, , and cancer. negative effect on

fertility in women and fetal alcohol syndrome in pregnant

women.

Psychiatric d.Cognitive : Loss of memory, dementia. anxiety,depression , suicide. Psychosis, Panic disorder .Primary psychiatric disorders in women: depression, anxiety, panic, bulimia, (PTSD), or borderline personality disorder. Primary psychiatric disorders in Men: narcissistic or antisocial personality disorder, bipolar disorder, schizophrenia, impulse disorders or attention deficit/hyperactivity disorder.

Social d. Increased risk of committing criminal offences: child abuse, domestic violence, rape, burglary , assault. loss of employment , financial problems .drunk driving ,socialIsolation: marital conflict ,divorce, child neglect

Alcohol withdrawal Syndromecan be fatal if not properly managed. Alcohol: increase in stimulation of the GABAA receptor leads to central nervous system depression. anxiety, life threatening ,seizures, delirium tremens, hallucinations, delusions,shakes, possible heart ,failure. insomnia and, anhedonia.

DiagnosisHistory. CAGE questionnaire, 1. Cut down? 2.Annoyed? 3.Guilty feeling ? 4.Eye-opener mornings?Investigations: blood alcohol content (BAC). Macrocytosis (enlarged MCV),Elevated GGT, AST and ALT and an AST: ALT ratio of 2:1.High carbohydrate deficient transferrin (CDT), Sonography: liver and pancrease changes.

PreventionEducational campaigns in the mass media about the consequences of alcohol abuse. Guidelines for parents to prevent alcohol abuse amongst adolescents, and for helping young people with mental health problems.

ManagementComplete abstinence vs. controlled drinking.1.Detoxification: stop alcohol, substitution w. drugs:benzodiazepines. Outpatient or inpatient. 2.Psychotherapy: Group and individual, family. 3.Relapse prevention skills. 4.Specific Therapy :underlying psychiatric disease.5. Self-help groups: Alcoholics Anonymous.

Medications:1. Substition w. benzodiazepines while detoxifying. 2.Vit.B1. 3. Aversion therapy with Antabuse (disulfiram) 4.Anti-craving therapy with: Campral (acamprosate) or Naltrexone. 5.Anticonvulsives when Withdrawal seizures