Alcohol Misuse

Alcohol consumption associated with social, psychological and physical

problems
Few facts:

• About 90% of adult population drinks alcohol at some time.

• Alcohol is implicated in 40% of all RTA, 50% of murders and 80% of
suicides
Safe limits and its calculation

• 14 Units in a week for both men and women with 2 alcohol free days
(?) and not more than 3 Units in a day.

• 1 Units = Amount of alcohol that can be metabolized by an average

human body within 1 hour. I.e. 10ml/8g.
No. of Unit= % of alcohol ingested * amount ingested in ml/1000
 Classification

• Alcohol Intoxication: slurred speech , impaired coordination and

judgement, labile affect, and in severe cases hypoglycemia, stupor and
coma, accidental injuries.

• Alcohol withdrawal : reflects the degree of previous dependence

• Alcohol dependence
 Alcohol withdrawl

• Complicated and uncomplicated withdrawl

Alcohol dependence
Physical effects of Dependence
 Psychiatric and cerebral Effects

• Depression: In majority depression resolves within 2 weeks of stopping drinking

• Suicide: depression and disinhibiting effect of alcohol, social problems and poor
physical health are responsible.

• Alcoholic hallucinosis: mostly auditory. Unlike schizophrenia, there are no

delusions, thought disorder and other first rank symptoms. Trt: antipsychotics

• Alcoholic dementia
Contd…

• Wernicke’s encephalopathy and korsakoff’s psychosis:

Thiamine deficiency is due to : no nutritional value of alcohol
worsened by decreased absorption and impaired storage.
Etiology
 Assessment

•History and physical examination

•Mental state examination
•Screening questionnaire
•Liver function test, Complete blood count
And peripheral blood smear.
Treatment
Management of withdrawal and prevention of relapse

1. Management of withdrawal: Admit if complicated withdrawal/the person is

child or vulnerable.
Initially high sedation with benzodiazepine ( DOC: Chlordiazepoxide with rapid
tapering).
In delirium tremens : Lorazepam(DOC) or antipsychotics

Additional: rehydration, correction of electrolyte imbalance and hypoglycemia, oral

or parenteral thiamine.
Contd…..

2. Prevention of relapse
a. Disulfiram(200-400 mg daily): to resist the impulse. Patient must be
motivated to stop drinking and should have been alcohol free for at
least 24 hours. It causes accumulation of acetaldehyde leading to
unpleasant reaction with headache, flushing and nausea.
b. Acamprosate or naltrexone: reduces craving.
c. Residential rehabilitation programs.
d. Self help organizations.
Other substance abuse disorder .