Chapter 5 Alcohol Withdrawal Syndrome Alcohol Withdrawal Syndrome

138 Pages·2012·5.03 MB·English

Revised Edition: 2016
ISBN 978-1-280-19949-3
© All rights reserved.
Published by:
College Publishing House
48 West 48 Street, Suite 1116,
New York, NY 10036, United States
Email: [email protected]
Table of Contents

Chapter 1 - Alcohol Abuse
Chapter 2 - Alcohol Dependence and Alcohol Flush Reaction
Chapter 3 - Alcohol Intoxication
Chapter 4 - Psychosis
Chapter 5 - Alcohol Withdrawal Syndrome
Chapter 6 - Post–Acute Withdrawal Syndrome
Chapter 7 - Alcoholism
WT
Chapter 8 - Fetal Alcohol Syndrome
Chapter 9 - Alcoholic Hepatitis and Cirrhosis
Chapter 10 - Alcoholic Liver Disease
Chapter 11 - Delirium Tremens
Chapter 12 - Alcohol Dementia and Alcoholic Hallucinosis
Chapter 13 - Alcohol and Cardiovascular Disease
Chapter 14 - Blackout (Alcohol-Related Amnesia) and Wernicke-Korsakoff
Syndrome
Chapter 15 - Alcoholic Cardiomyopathy and Alcoholic Lung Disease
Chapter 16 - Hepatorenal Syndrome
Chapter 17 - Kidney Stone
________________________WORLD TECHNOLOGIES________________________
Chapter 1
Alcohol Abuse

Alcohol abuse
ICD-10 F10.1
ICD-9 305.0
MeSH D000437
Alcohol abuWse, as described in the DSM-IV, is aT psychiatric diagnosis describing the
recurring use of alcoholic beverages despite negative consequences. Alcohol abuse is
sometimes referred to by the less specific term alcoholism. However, many definitions of
alcoholism exist, and only some are compatible with alcohol abuse. Binge drinking is
another form of alcohol abuse. Frequent binge drinking or getting severely drunk more
than twice is classed as alcohol misuse.
Definitions
Alcohol abuse is a pattern of drinking that results in harm to one’s health, interpersonal
relationships, or ability to work. According to Gelder, Mayou & Geddes (2005) alcohol
abuse is linked with suicide. They state the risk of suicide is high in older men who have
a history of drinking, also if a person is suffering from depression. Certain manifestations
of alcohol abuse include failure to fulfill responsibilities at work, school or home;
drinking in dangerous situations, such as while driving; legal problems associated with
alcohol use; and continued drinking despite problems that are caused or worsened by
drinking. Alcohol abuse can lead to alcohol dependence.
Alcohol abuse has both short-term and long-term risks. If a person has driven while
drunk or regularly binge drinks (more than 5 or 6 standard drinks in one drinking
session), they are considered to have been involved in alcohol abuse. Short-term abuses
of alcohol include, but are not limited to, violence, injuries, unprotected sexual activities
and additionally social and financial problems.
________________________WORLD TECHNOLOGIES________________________
Binge Drinking
In the USA, binge drinking is defined as consuming more than 5 drinks in men and 4
drinks in women. It increases chances for vandalism, fights, injuries, drunk driving,
trouble with police, and negative health, social, economic, or legal consequences to
occur. Binge drinking is also associated with neurocognitive deficits of frontal lobe
processing and impaired working memory as well as delayed auditory and verbal
memory deficits. Binge drinking combine with the stress of returning to work is a
contributing factor to Monday deaths from heart attacks.
Symptoms & Signs
Symptoms are the defining characteristic of alcohol abuse and are reviewed above in
Definitions. Patient will often complain of difficulty with interpersonal relationships,
problems at work or school, and legal problems. Additionally patients do complain of
irritability and insomnia.
Signs of alcohol abuse are related to alcohol's effects on organ systems. However, while
these findingWs are often present, they are not neceTssary to make a diagnosis of alcohol
abuse. Signs of alcohol's effects on the central nervous system acutely include inebriation
and poor judgment; chronic anxiety, irritability, and insomnia often feature. Alcohol's
effects on the liver include elevated liver function tests (classically AST is at least twice
as high as ALT). Prolonged use leads to cirrhosis and failure of the liver. With cirrhosis
patients develop an inability to process hormones and toxins. The skin of a patient with
alcoholic cirrhosis can feature cherry angiomas, palmar erythema and - in fulminent liver
failure - jaundice and ascities. The derrangements of the endocrine system lead to
gynecomastia. Inability to process toxins leads to hepatic encephalopathy.
Binge drinking is associated with individuals reporting fair to poor health compared to
non-binge drinking individuals and which may progressively worsen over time. Binge
drinking is associated with alcohol poisoning, unintentional injuries, suicide,
hypertension, pancreatitis, sexually transmitted diseases, and meningitis, among other
disorders. Other negative consequences include social costs (including interpersonal
violence), drunk driving, and lost economic productivity. Impairments in neuro-
physiological and neurocognitive function can result from binge drinking. A substantial
proportion of alcohol-related deaths are due to binge drinking.
Causes
Peer pressure influences individuals to abuse alcohol; however most of the influence of
peers is due to inaccurate perceptions of the risks of alcohol abuse. According to Gelder,
Mayou and Geddes (2005) easy accessibility of alcohol is one of the reasons people
engage in alcohol abuse as this substance is easily obtained in shops.

________________________WORLD TECHNOLOGIES________________________
Prevention
Preventing or reducing the harm has been called for via increased taxation of alcohol,
stricter regulation of alcohol advertising and the provision of brief Interventions. Brief
Interventions for alcohol abuse reduce the incidence of unsafe sex, sexual violence,
unplanned pregnancy and, likely, HIV transmission. Information and education on social
norms and the harms associated with alcohol abuse delivered either via the internet or
face to face has been found to result in a decrease in harmful drinking behaviours in
young people.
Epidemiology
Alcohol abuse is most common in people aged between 15 and 24 years.
Societal and economic costs
Alcohol abuse is associated with disabilities and death, accidents, fights, driving offenses
and unprotected sex. Alcohol is responsible in the world for 1.8 million deaths and results
WT
in disability in approximately 58.3 million people. Approximately 40 percent of the 58.3
million people disabled through alcohol abuse are disabled due to alcohol related
neuropsychiatric disorders. Due to increased unsafe sex associated with alcohol, there is a
doubling of the risk of HIV infection in alcohol abusers. Additionally alcohol abuse
increases the risk of individuals either being the victim of sexual violence or being the
perpetrator of sexual violence.
Alcohol misuse costs the National Health Service (UK) 3 billion pounds sterling per year
and the cost to employers is 6.4 billion pounds sterling per year. These figures do not
include the crime and social problems associated with alcohol misuse. The number of
women regularly drinking alcohol has almost caught up with men.
Prognosis
Alcohol abuse during adolescence, especially early adolescence (i.e. before age 15), may
lead to long-term changes in the brain which leaves them at increased risk of alcoholism
in later years; genetic factors also influence age of onset of alcohol abuse and risk of
alcoholism. For example, about 40 percent of those who begin drinking alcohol before
age 15 develop alcohol dependence in later life, whereas only 10 percent of those who
did not begin drinking until 20 years or older developed an alcohol problem in later life.
It is not entirely clear whether this association is causal, and some researchers have been
known to disagree with this view.
College/university students who are heavy binge drinkers (3 or more times in the past 2
weeks) are 19 times more likely to be diagnosed with alcohol dependence, and 13 times
more likely to be diagnosed with alcohol abuse compared to non-heavy episodic drinkers,
though the direction of causality remains unclear. Occasional binge drinkers (one or two
________________________WORLD TECHNOLOGIES________________________
times in past 2 weeks), were found to be 4 times more likely to be diagnosed with alcohol
abuse or dependence compared to non-heavy episodic drinkers.
Alcopops
The introduction of alcopops, which are flavoured alcoholic drinks which have a sweet
and pleasant taste was responsible in Sweden for half of the increase in alcohol abuse in
15-16 year olds in a survey. In the case of girls the alcopops, which disguise the taste of
alcohol, were responsible for two thirds of the increase. The introduction of alcopops to
Sweden was a result of Sweden joining the European Union and adopting the entire
European Union law. Alcohol abuse is highly associated with adolescent suicide.
Adolescents who abuse alcohol are 17 times more likely to commit suicide than
adolescents who don't drink.
Association with violence
Alcohol abuse is significantly associated with suicide and violence. Alcohol is the most
significant health concern in Native American communities because of very high rates of
WT
alcohol dependence and abuse; up to 80 percent of suicides and 60 percent of violent acts
are a result of alcohol abuse in Native American communities.
The overuse of alcohol has led to 16% of intoxicated people that have abused children.
Abusing children can also come in the form of verbal abuse while under the influence, as
well as physical abuse. Alcohol can impare one's judgement and make emotions more
easily emphasized, such as anger towards a minor topic, which can cause them to become
dangerous.
________________________WORLD TECHNOLOGIES________________________
Chapter 2
Alcohol Dependence and Alcohol Flush
Reaction

Alcohol dependence
Alcohol Dependence
ICD-10 WF10..2 T
ICD-9 303
Alcohol dependence, as described in the DSM-IV, is a psychiatric diagnosis (a substance
related disorder DSM-IV) describing an entity in which an individual uses alcohol despite
significant areas of dysfunction, evidence of physical dependence, and/or related
hardship.
Definition and diagnosis
According to the DSM-IV criteria for alcohol dependence, at least three out of seven of
the following criteria must be manifest during a 12 month period:
• Tolerance
• Withdrawal symptoms or clinically defined Alcohol Withdrawal Syndrome
• Use in larger amounts or for longer periods than intended
• Persistent desire or unsuccessful efforts to cut down on alcohol use
• Time is spent obtaining alcohol or recovering from effects
• Social, occupational and recreational pursuits are given up or reduced because of
alcohol use
• Use is continued despite knowledge of alcohol-related harm (physical or
psychological)
________________________WORLD TECHNOLOGIES________________________
History and epidemiology
About 12% of American adults have had an alcohol dependence problem at some time in
their life. Alcohol dependence is acknowledged by the American Medical Association as
a disease because it has a characteristic set of signs and symptoms and a progressive
course.
The contemporary definition of alcohol dependence is still based upon early research.
There has been considerable scientific effort over the past several decades to identify and
understand the core features of alcohol dependence. This work began in 1976 when the
British psychiatrist Griffith Edwards and his American colleague Milton M. Gross
collaborated to produce a formulation of what had previously been understood as
‘alcoholism’ – the alcohol dependence syndrome.
The alcohol dependence syndrome was seen as a cluster of seven elements that concur. It
was argued that not all elements may be present in every case, but the picture is
sufficiently regular and coherent to permit clinical recognition. The syndrome was also
considered to exist in degrees of severity rather than as a categorical absolute. Thus, the
proper questiWon is not ‘whether a person is dependeTnt on alcohol’, but ‘how far along the
path of dependence has a person progressed’.
Screening tools
The Alcohol Use Disorders Identification Test (AUDIT) is the most accurate alcohol
screening tool for identifying potential alcohol misuse, including dependence. It was
developed by the World Health Organisation, designed initially for use in primary
healthcare settings with supporting guidance . Its use has replaced older screening tools
such as CAGE but there are many shorter alcohol screening tools, mostly derived from
the AUDIT. The Severity of Alcohol Dependence Questionnaire (SAD-Q) is a more
specific twenty item inventory for assessing the presence and severity of alcohol
dependence.
Comparisons with other alcohol-related disorders
Because only 3 of the 7 DSM-IV criteria for alcohol dependence are required, not all
patients meet the same criteria and therefore not all have the same symptoms and
problems related to drinking. Not everyone with alcohol dependence, therefore,
experiences physiological dependence. Alcohol dependence is differentiated from alcohol
abuse by the presence of symptoms such as tolerance and withdrawal. Both alcohol
dependence and alcohol abuse are sometimes referred to by the less specific term
alcoholism. However, many definitions of alcoholism exist, and only some are
compatible with alcohol abuse. There are two major differences between alcohol
dependence and alcoholism as generally accepted by the medical community.
________________________WORLD TECHNOLOGIES________________________
1. Alcohol dependence refers to an entity in which only alcohol is the involved
addictive agent. Alcoholism refers to an entity in which alcohol or any cross-
tolerant addictive agent is involved.
2. In alcohol dependence, remission as defined within DSM-IV can be attained
despite continued use of alcohol. That is, a patient can be in full sustained
remission yet still be drinking alcohol so long as the patient does not meet the
noted criteria. In alcoholism, patients are generally not presumed to be in
remission unless they are abstinent from alcohol.
The following elements are the template for which the degree of dependence is judged:
1. Narrowing of the drinking repertoire.
2. Increased salience of the need for alcohol over competing needs and
responsibilities.
3. An acquired tolerance to alcohol.
4. Withdrawal symptoms.
5. Relief or avoidance of withdrawal symptoms by further drinking.
6. Subjective awareness of compulsion to drink.
7. Reinstatement after abstinence.
WT

Alcohol flush reaction
Alcohol flush reaction (colloquially referred to as Asian Flush, Asian Red or Asian
Glow) is a condition in which the face and/or body experiences flushes or blotches, due
to an accumulation of acetaldehyde. The acetaldehyde accumulation can be caused by a
missense polymorphism that encodes the enzyme, acetaldehyde dehydrogenase
(ALDH2), normally responsible for breaking down acetaldehyde, a product of the
metabolism of alcohol. The acetaldehyde accumulation can also be caused by a
polymorphism in the gene encoding the ADH1B enzyme, increasing production of
acetaldehyde by more rapid metabolism of alcohol. Flushing, or blushing, is associated
with the erythema (reddening caused by dilation of capillaries) of the face, neck,
shoulder, and in some cases, the entire body after consumption of alcohol.
Research has shown that a history of facial flushing when drinking is indicative of
ALDH2 deficiency, and that an ALDH2-deficient drinker who drinks 2 beers per day has
6 to 10 times the risk of developing esophageal cancer as a drinker not deficient in the
enzyme.
Mitigating the effects
Anecdotal evidence suggests that ingestion of low doses of heartburn medicine,
containing ranitidine or famotidine (such as Zantac or Pepcid AC), may be able to relieve
________________________WORLD TECHNOLOGIES________________________