Alcoholism

Samjhana gautam
Alcohol use disorder or Alcoholism

• Alcohol is a beverage which has central

nervous system depressant property and thus
produces general relaxation, promoting sleep
and giving sense of well being
Alcoholism
• Alcoholism is a chronic dependence
characterized by compulsive drinking of alcohol
to such degree that it produces mental
disturbance, interferes with social economic
functioning. Major signs of the addiction are
increasing consumption, sneaking and gulping
drinks, morning drinking, excessive drinking
when alone, confusion and tremors, uninhibited
behaviors and severe withdrawal symptoms
Features of alcohol intoxication
• Alcohol on the breath
• Unstable gait or slurred speech
• Depressed or elated mood
• Blood shot eye
• Accidents or injuries
• Unnecessary talk, fights and quarrels
• Physical complications eg. Liver disease, gastritis, jaundice
• Alcohol withdrawal features eg. Anxiety, tremor, sweating,
insomnia, fearfulness, muscle pain etc
• Building tolerance to alcohol
Physical complications
• GI System:
Gastritis
Malabsorption syndrome
Alcoholic hepatitis
Alcoholic cirrhosis
• CV System:
Alcoholic cardiomyopathy
Myocardial infraction
• Endocrine System:
Pancreatitis
Diabetes
• Reproductive system:
HIV infection
Sexual dysfunction
• Nervous System:
Korsakoff’s syndrome
Wernicke’s encephalopathy

• Hematological system:
Anemia
Leucopenia
Thrombocytopenia

Alcohol induced fracture

Psychiatric complications
• Pathological intoxication
• Withdrawal phenomena
• Delirium tremens (DT)
• Alcoholic hallucinosis
• Alcoholic psychosis
• Morbid jealousy
• Alcohol and specific psychiatric illness
• Alcoholism and criminality
• Sexual dysfunction
• Alcohol amnestic disorder
• Alcohol dementia
Other complications
• Social complications
• Legal problems
Diagnostic investigations
• Blood alcohol level
• Complete blood count
• Liver function test
• Total protein
• Serum magnesium
• Uric acid
Prevention of alcoholism
• Primary prevention
• Secondary prevention
• Tertiary prevention
Primary prevention
A teenager should be:
• Helped to prevent alcohol use. Start by setting a good example with
your own
• Talked openly with the child and spent time together, but respecting
his need for independence
• Made sure child understands the legal and medical consequences of
drinking
• Watched for the signs and symptoms that may indicate a problem
alcohol:
- Less or no interest in activities and hobbies
- Blood shot eyes
- Slurred speech
- Difficulties or changes in relationship with friends, often
characterized by joining a new crowd
- Declining grades and problems in school
- Frequent mood changes
Primary prevention
• The price of the alcohol and alcoholic beverages should be put
up
• Restricting availability and lessening social deprivation
• Controlling or abolishing the advertising of alcoholic drinks
• Control on sales
• Health education and awareness programs against alcohol use
• Incorporate substance related issues in the high school
curriculum
• School community talk program against alcohol
• Regulation of production, distribution, sell and consumption
with special consideration of age, bar, time, and location of sell
• Integration of substance use related problem with general
health system
Prevention…
• Secondary prevention
Can be done with early identification of heavy
alcohol drinker and their treatment

• Tertiary prevention
It is mainly concerned with relapse prevention
and rehabilitation
Management of alcoholism
• Assess the problem
• Motivate the patient to stop drinking
• Screening of the patient
Screening is done through CAGE questionnaire:
C- Have you ever had to cut down on alcohol?
A- Have you ever annoyed by people’s criticism of
alcoholism?
G- Have you ever felt guilty about drinking?
E- Have you ever need eye opener drink?
Management of alcoholism condt…
• Treatment of withdrawal
Pharmacotherapy:
Chlordiazepoxide 80-200mg orally or
Diazepam 40-80 mg orally
• Examination and treatment
- Antianxiety
- Antidepressnat
- Vitamin replacement e.g. vit. B complex
- Fluid and electrolyte replacement
- Treatment of hypoglycemia
Management of alcoholism condt…
• Psychosocial management
- Behavior therapy
- Supportive and individual psychotherapy
- Group therapy
- Family/ marital therapy
- Social therapy
• Deterrent agent e.g. disulfiram therapy
• Medications to prevent relapse e.g. methadone,
naltrexone etc.
• Rehabilitation i.e. psychosocial rehabilitation