Transcript Alcoholism and Substance Abuse

Alcoholism and
Substance Abuse
Focus
Alcoholism
Phenomenology
Definitions
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Intoxication
Addiction
Tolerance
Physical
Dependence
Withdrawal
Substance
Dependence
Substance Abuse
Intoxication
Reversible,
Substance-specific
physiological and behavioral changes
due to recent exposure to a
psychoactive substance.
Tolerance
The decline in potency
continued use
 higher doses are needed for same effect.
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Receptor mediated
Common
Physical Dependence
The development of withdrawal
symptoms once a drug is stopped.
Withdrawal
A physiological state
Cessation/reduction in amount of drug
Generally opposite of drug’s normal
effects.
Addiction
Compulsion
Psychic, rather than therapeutic, effects
Other Terms
Alcoholism
DSM-related terms
Substance dependence
 Substance Abuse
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Epidemiology
Substance Use
100
80
Alcohol
60
40
20
0
Caffeine
Tobacco
Illicit
Alcohol Dependence
Very common
ECA: ~14%
 > 10 million Americans
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Another 8 million “problem drinkers”
 Only 3% “skid row”
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Epidemiology: Illicit
Abuse (%)
14
A lc o h o l
12
10
Amp h e t
C a n n a b is
8
C o c a in e
6
H a llu c in .
4
2
0
O p io id s
Tr a n q u iliz e r s
Alcohol Dependence
Gender
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% >> &
Probably 2 types
Alcohol Dependence:
Age
More common in adults, but...
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Teenage also common
15% HS 5+ drinks/occasion/week
 31% HS intoxicated 6+/year
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Under-Dx in elderly
♂: alcohol
 ♀: look for prescription drugs
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Alcohol Dependence:
Social Factors
More common
Rural
 Undereducated
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Low socioeconomic
Less likely to drink
 More likely to abuse
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Alcohol Dependence:
Socioeconomics
Associated with
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Unstable marriages
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Increase risk divorce 3X
Unstable work
Alcohol Dependence:
Medical Ramifications
20-50% hospital admissions
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May be unrecognized
~20% ER visits
80% of cirrhosis
33% of suicides
Pathology
Pathology of
Acute Physiological
Tolerance
 Withdrawal
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Addiction
Etiology
Etiology of Substance
Abuse: Genetics
1 parent:
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20%
2 parents
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20-50%
sons of father
50%
 if severe alcoholic and criminal:
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90% risk in son.
Genetics
Twins
fraternal:28%
 identical: 54%
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Adopted
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Danish Adoption Study (1974)
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adopted sons of alcoholics raised by nonalcoholic foster parents still had increased risk of
alcoholism.
Social Influences
Diagnosis
Diagnosis
Substance Dependence
Maladaptive pattern of substance use
$ 3 or more (1 year):
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Tolerance
Withdrawal
larger amounts
Desire/Cut down
Time spent
Activities
Continued use
Diagnosis
Substance Abuse
Maladaptive pattern
$ 1 (1 year)
recurrent use 6failed obligations
 hazardous use
 Legal problems
 Continued use despite causing
interpersonal or social problems.
 R/O: Substance dependence
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Other Diagnoses
Substance Intoxication
Substance Withdrawal
Diagnoses:
Other substances
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Alcohol
Amphetamines and related
Caffeine
Cannabis
Cocaine
Hallucinogens
Inhalants
Nicotine
Opioids
Phencyclidine and related
Sedatives
Polysubstance Abuse ($ 3)
Other
Diagnosis
Other Schemas for Alcohol
Greek letters
 Typologies
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Diagnosis
CAGE Questionnaire
Have you ever felt the need to Cut down on
drinking
 Have you ever felt Annoyed by criticisms of
drinking
 Have you ever had Guilty feelings about
drinking
 Have you ever taken a morning Eye opener
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Diagnosis
Clues
History
 Physical
 Labs
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Differential
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Normal use
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What’s normal?
Comorbid Disorders and
Complications
Alcohol Withdrawal
Uncomplicated
 Seizures
 Hallucinosis
 DT’s
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Comorbid Disorders and
Complications
Fetal Alcohol Syndrome
 Comorbid Medical Disorders
 Comorbid Psychiatric Illnesses
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Course
Relapses and remission
Predictors
Gender
 Age of onset
 Family history
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Treatment
Treatment
General Principles
Alcohol
Acute treatment: Manage withdrawal
 Long term treatment: Abstinence
 Question of Controlled Use
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Detox
Long Term Treatment
Modalities
Groups
Family therapy
Medications
Medication Treatment
Disulfiram
Naltrexone
Other
Contraindicated
“Yes, Billy, but Mr. Phillips
pushes legal drugs.”
Treatment: General
Rules
Supportive care
Sobriety is goal
Work (don’t compete) with AA
Identify triggers of relapse
Anticipate relapses, encourage return
Reasonable goals
Treatment
Efficacy
NIAAA data
70% recovery after 18 months
 50% needed only minimal intervention
 abstinence related to intensity (not length)
of tx.
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Alcoholics Anonymous
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40% retention in 12 months