ALCOHOL

&
HEALTH

Dr. Ahamed Riyaaz

MBBS, MD, FRCP
Consultant Physician/Senior Lecturer
Objectives
Introduction
Epidemiology
Alcohol use disorders
Alcohol toxicity – Acute
Alcohol toxicity – Chronic
Alcohol withdrawal syndrome & Management
Prevention of Alcohol dependence
Alcohol Metabolism
Patterns of Drinking: Definitions
One Unit of Alcohol
Alcohol Abuse - Epidemiology

Global prevalence rate among adults 0-16% in

2004(WHO)
Highest prevalence in Eastern Europe
M>F
In Sri Lanka prevalence of hazardous drinking
Overall 2.5% Men 5.6%
Alcohol Use Disorders(AUD)
Alcohol Use Disorders(AUD)
Alcohol Abuse
Alcohol Dependence
(3 of 7 during one year required for diagnosis)
Acute Alcohol Toxicity
 Chronic Alcohol Toxicity

Physical
Psychological
Social
Chronic Alcohol Toxicity-Physical
Chronic Alcohol Toxicity- Psychological
Chronic Alcohol Toxicity-Social
Alcohol Withdrawal Syndrome
Alcohol Withdrawal Syndrome - Management

Mild – Outpatient Mx
Severe or Delirium Tremens: Hospital admission (Emergency)
IV Thiamine 250-500 mg/d for 3-5 days (prevention or
treatment of Wernicke's encephalopathy)
Correct dehydration and electrolyte imbalance
Specific Treatment:
Diazepam 10 mg 6H for 4 doses, 5mg 6H for 8 doses
Chlordiazepoxide 30 mg 6H for 4 doses, 15 mg 6H for 8 doses
Prevention of Alcohol Dependence
Non-pharmacological
Counselling with motivational therapy
Based on 5 stages of change: pre-contemplation,
contemplation, determination, action and
maintenance.
Motivational interviewing and reflective listening
to allow the patient to persuade himself along the
five stages to change.
Prevention of Alcohol Dependence

Pharmacological
Naltrexone(opioid antagonist)- 50 mg/d
Acamprosate – 1-2 g/d
Both reduce drinking frequency but not helpful in
maintenance
Disulfiram – causes unpleasant intoxication when
taken with alcohol
Oral thiamin 300 mg/d to prevent WE in heavy drinkers
Assessment of Alcohol Use

Duration
Amount ( Number of standard drinks/units per day/week)
Pattern of drinking (moderate/binge/heavy/excessive)
Presence or absence of alcohol abuse
Presence or absence of alcohol dependence
Presence or absence of chronic toxicity
(physical/psychological/social)
AVOID THE TERM ALCOHOLIC