Mental Health Book

Alcohol Use Disorders

Amphetamine Use Disorders

Background Information

Compulsive Behavior

Hallucinogen Use Disorders

Miscellaneous

Sedative Abuse

Tobacco Use Disorders

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Alcohol AbuseAka: Alcohol Dependence, Alcoholism, Problem Drinking

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  1. See Also
    1. Chemical Dependency
  2. Epidemiology: General
    1. Lifetime Prevalence Alcohol dependence: 8-14%
    2. Age of symptom onset: 15 to to 19 years
    3. Familial predisposition in autosomal dominant pattern
  3. Epidemiology: Alcohol Impaired Driving
    1. Alcohol Impaired Driving Survey (n=102,263)
      1. Overall Alcohol impaired driving in last month: 2.5%
      2. Lowest rate: Women over age 55 years old (0.1%)
    2. Predictors of Alcohol impaired driving
      1. Men aged 21 to 34 years: 7%
      2. Over 4 Alcoholic drinks on 1 occasion in last month
      3. Greater than two Alcoholic drinks per day
    3. States of highest Alcohol impaired driving
      1. Alaska
      2. Nevada
      3. Wisconsin
      4. Michigan
      5. North Dakota
    4. References
      1. Liu (1997) JAMA 277:122
  4. History: Famous Alcoholics
    1. Sinclair Lewis
    2. Edgar Allen Poe
    3. Dylan Thomas
    4. F. Scott Fitzgerald
    5. Jim Thorpe
  5. Pathophysiology
    1. See Addiction Pathophysiology
    2. Substance Abuse or Alcoholism Definition Criteria
      1. Compulsion-Preoccupation
      2. Use despite adverse consequences
      3. Loss of Control
      4. Denial
    3. Mechanism
      1. Limbic System drive state
      2. Alcoholics have lower level of endogenous endorphins
        1. Need TIQs externally from Alcohol to feel normal
  6. Alcohol Digestion Pathway
    1. One ounce Alcohol takes 1 hour, mouth to excretion
    2. No digestion required before absorption
    3. Small amount absorbed in stomach
    4. Most Alcohol absorbed in small intestine (duodenum)
    5. Metabolism
      1. Alcohol converted to acetaldehyde
      2. Acetaldehyde converted in liver to acetic acid
    6. Excretion
      1. Renal excretion: 10%
      2. Hepatic excretion: 90%
  7. History of Alcohol use
    1. See Alcoholism Screening
      1. CAGE Questions
      2. NIAAA Quantity and Frequency Questionnaire
    2. See Alcohol Dependence DSM-IV Criteria
    3. See Substance Abuse Evaluation
    4. See medical complications and comorbid conditions below
    5. Alcohol use history (See Grading Alcohol Use)
      1. Drinks per day
      2. Last drink
      3. Binge drinking
    6. Other Illicit Drug use
      1. Marijuana
      2. Cocaine
      3. Heroin
      4. Amphetamines
      5. Benzodiazepine Abuse
      6. Barbiturate Abuse
      7. Quaalude
      8. Hallucinogen
    7. Prior attempts at cessation
      1. Greatest duration of sobriety
      2. Trials of cold turkey
      3. Rehabilitation Programs
      4. Detox Center Admissions
    8. Overuse Complications
      1. Blackouts
      2. Seizures
      3. Hangovers
    9. Accidents
      1. Motor vehicle accidents
      2. Driving while intoxicated (DUI or DWI)
    10. Injuries
      1. Frequent falls or minor trauma
      2. Burns
      3. Violence
    11. Withdrawal complications
      1. See Alcohol Withdrawal
      2. Hallucinations
      3. Delirium Tremens (DT's)
      4. Grand Mal Seizures (GTCS)
  8. Evaluation
    1. See Alcoholism Screening
    2. See Substance Abuse Evaluation
    3. See Skin changes suggestive of chemical dependency
    4. See Eye Examination Signs of Chemical Dependency
  9. Labs
    1. See Substance Abuse Evaluation
    2. Increased blood Alcohol level or breath analysis
    3. Toxicology Screening for other drug use
    4. Complete Blood Count with increased MCV
      1. Non-megaloblastic Macrocytic Anemia
    5. Lipid panel
      1. Low High Density Lipoprotein
      2. High Triglycerides
    6. Monitoring (labs correlating with increased use)
      1. Gamma glutamyl transferase (GGT)
      2. Carbohydrate-deficient Transferrin
        1. Limited availability
    7. Liver Function Tests
      1. Alkaline Phosphatase
      2. Alanine Aminotransferase (ALT, SGPT)
      3. Aspartate Aminotransferase (AST, SGOT)
  10. Comorbid Conditions: Psychiatric Illness
    1. Mood Disorder
      1. Major Depression
      2. Anxiety
        1. Generalized Anxiety Disorder
        2. Panic Attacks
        3. Agoraphobia
        4. Social Phobia
      3. Bipolar Disorder
    2. Schizophrenia
    3. Borderline Personality Disorder
    4. Antisocial Personality Disorder
    5. Other Drug Abuse
      1. Tobacco abuse: >1 pack per day in 70% of Alcoholics
    6. Post-Traumatic Stress Disorder (Veterans)
  11. Comorbid Conditions: Infectious disease
    1. Tuberculosis
    2. AIDS
    3. Viral Hepatitis
  12. Medical Complications
    1. Wernicke's Encephalopathy
    2. Korsakoff's Disease
    3. Alcoholic Hepatitis
    4. Cirrhosis
    5. Pancreatitis
    6. Esophageal Varices
    7. Macrocytic Anemia
    8. Peptic Ulcer Disease
    9. Fetal Alcohol Syndrome (children of female Alcoholics)
  13. Management
    1. See Alcohol Dependence Management
    2. See Alcohol Withdrawal
    3. See Substance Addiction Aftercare
  14. Prognosis: Relapse after CD treatment
    1. Relapse after Treatment in first 3 months: 50%
    2. Relapse after treatment in first 6 months: 80%
    3. Remain sober with Alcoholics Anonymous > 1 year: 76%
  15. Resources
    1. See Chemical Dependency Resources
    2. Alcoholics Anonymous
      1. http://www.alcoholics-anonymous.org/
    3. Al-Anon/Ala-Teen (Family and Friends of Alcoholics)
      1. http://www.al-anon.org/
    4. Information from your Family Doctor: Alcohol Abuse
      1. http://www.familydoctor.org/healthfacts/006
  16. References
    1. Beddingfeld (July, 1996) Hospital Physician 27-39
    2. (1994) Am Fam Physician 50(8):1737
    3. Blondell (1996) Postgrad Med 100(1):69
    4. Chang (1995) Am Fam Physician 52(8):2267
    5. Enoch (2002) Am Fam Physician 65(3):441
    6. Figueredo (1997) Postgrad Med 101(2):165
    7. Gearhart (1991) Am Fam Physician 44(3):907
    8. Tobias (1989) Postgrad Med 86(4):67

Alcoholic Intoxication, Chronic (C0001973)

Definition (MSH)A primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic. (Morse & Flavin for the Joint Commission of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to Study the Definition and Criteria for the Diagnosis of Alcoholism: in JAMA 1992;268:1012-4)
Definition (CSP)a disorder characterized by a pathological pattern of alcohol use that causes a serious impairment in social or occupational functioning.
ConceptsMental or Behavioral Dysfunction (T048)
ICD9303, 303.9
BasqueALKOLAREN ABUSU KRONIKOA
DanishKronisk alkoholmisbrug
DutchChronisch alcohol misbruik
Englishalcohol addiction, alcohol dependence, Alcohol dependence syndrome, Alcohol problem drinking, ALCOHOLIC INTOX CHRONIC, alcoholism, alcoholism/alcohol abuse, Chronic alcohol abuse, Chronic Alcoholic Intoxication, Chronic alcoholism, Dipsomania, Persistent alcohol abuse, Unspecified chronic alcoholism
FinnishJATKUVA/KROONINEN ALKOHOLIN VAARINKAYTTO
FrenchAlcoolisme
GermanAlkoholismus
Hebrewalkoholist
Hungarianchron. alkoholizmus
ItalianAbuso cronico di alcool
NorwegianLANGVARIG/KRONISK ALKOHOLPROBLEM
PortugueseAbuso cronico de alcool
Spanishabuso crónico de alcohol, abuso cronico de alcohol, Abuso del alcohol cronico, alcoholismo, alcoholismo crónico, alcoholismo crónico no especificado, alcoholismo cronico, alcoholismo cronico no especificado, dependencia de alcohol, dipsomanía, dipsomania
SwedishKRONISKT ALKOHOLMISSBRUK
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Alcohol abuse (C0085762)

Definition (NCI)The use of alcoholic beverages to excess, either on individual occasions ("binge drinking") or as a regular practice.
ConceptsMental or Behavioral Dysfunction (T048)
ICD9305.0, 305.00
EnglishAlcohol Abuse, dysfunctional alcohol use, Ethanol abuse, ETOH ABUSE, problem drinking
Spanishabuso de alcohol
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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