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Alcohol Use Disorder


OVERVIEW OF Alcohol Use Disorder :

It is a long term brain condition in which you can’t stop or control your drinking eventhough it is hurting your social life.

What is alcoholism?

It is classes as a depressant which slows vital functions resulting in slurred speech,unsteady movements,disturbed perception and inability to react quickly.

As a drug its use activates the dopamine pathway of the brain reward system that an intake of a certain drug will bring pleasurable effect.


EPIDEMIOLOGY :

According to the 2016 survey it is estimated that 300 million people world wide are affected by alcohol misuse.


COMMON CLINICAL SIGNS AND SYMPTOMS :

  • Hungover

  • Quit or cut down the important activities to you in order to drink

  • Keep having alcohol eventhough it causes harm to your health

  •  Having alcohol withdrawal symptoms such as shivering ,trouble sleeping,restlessness,nausea,a racing heart and seizures.


DIAGNOSTIC :

 

Breath analysis/blood alcohol level

Evidence of recent drinking:

Monitoring heavy drinking in men:

Gamma-glutamyltransferase

Carbohydrate-deficient transferrin—available in specialized centers

Nonspecific association:

Mean corpuscular volume

High-density lipoprotein cholesterol and triglyceride levels

High levels of CDT(carbohydrate deficient transferring)indicate heavy drinking.It is the only FDA approved

Test to rule out the deterioration in the alcohol consumption.

Evidence of liver impairment:

Serum glutamic oxaloactic transaminase level

Alkaline phosphatase level

Alkaline aminotransferase level. Assessment of alcohol abuse:

Addiction severity index

Alcohol clinical index

CAGE test for alcohol addiction:the survey is conducted on the basis:

C- questions asked if they felt to CUT down the alcohol.

A- if they were felt ANNOYED when others discussed about their heavy drinking.

G- questions raised if they felt GUILT about drinking

E- questions asked if they have used alcohol as an EYE OPENER to wake up and cure from a hangover in the morning.

AUDIT(alcohol use disorder identification test) TEST: This is an quistionnaire which is given to the patietnt to assess the severity of alcoholism.

OBSSESIVE COMPULSIVE DRINKING SCALE.


TREATMENT AND PROGNOSIS :

Brief intervention is the short term counselling therapy which motivates the patient to avoid alcohol usage. It has been shown effective in some indivduals. There are three major hurdles to overcome in the treatment of alcoholism: (a) physiologic dependence (symptoms of withdrawal), (b) psychologic dependence (alcohol used as treatment for anxiety, depression, stress), and (c) habit (the central part that alcohol occupies in the framework of daily living).

Alcohol dependence is treated in two stages: withdrawal and detoxification, followed by further interventions to maintain abstinence.

IMMEDIATE TREATMENT: DETOXIFICATION

Avoiding the alcohol from mind of chronic alcohol users  leads to withdrawal symptoms(delirium episodes and epilepsy).

Withdrawal severity and indications for pharmacotherapy can be assessed by the revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) instrument. Benzodiazepines reduces the risk of withdrawal symptoms.. Alcoholics should be admitted to the hospital if any complication arises due to withdrawal symptoms.

SUSTAINED TREATMENT: LONG-TERM MAINTENANCE OF ABSTINENCE :

Considerable evidence shows that long-lasting neurobiologic changes in the brains of alcoholics contribute to the persistence of craving. At any stage during recovery, relapse can be triggered by internal factors (depression, anxiety, craving for alcohol) or external factors (environmental triggers, social pressures, negative life events).23 Psychosocial treatments concentrate on helping patients to understand, anticipate, and prevent relapse.

BEHAVIORAL TREATMENT APPROACHES :

Alcoholics Anonymous (AA) and 12-Step Facilitation Therapy

AA and similar self-help groups follow 12 steps that alcoholics should work through during recovery. This free program is particularly supportive for those who are poor, isolated, lonely, or who come from a heavy-drinking social background. Twelve-Step Facilitation (TSF) is a formal treatment approach incorporating AA and similar 12-step programs.24

Cognitive-Behavior Therapy (CBT) :

The aim of this therapy is to educate the patient and recognize them severity of alcohol by doing the role play.

Motivational Enhancement Therapy (MET) :

motivating patients to use their own resources to change their behavior

Results of a large multisite study, Project MATCH,27 found that there was no difference in the efficacy of CBT, MET, and TSF during the year following treatment, however, MET was found to be most effective in those patients with high levels of anger, and TSF and AA involvement was particularly effective in patients from a heavy drinking social environment.27

PHARMACOTHERAPY : 

The pharmacotherapy plays a vital role in the contribution of reducing the alcoholism.

Anti-craving Medications :

Naltrexone(50mg once daily) reduces the alcohol consumption in both men and women. 

Acamprosate, used extensively in Europe and now under clinical trial in US shown to produce greater effects in the treatment of alcoholism.

Aversive Pharmacotherapy : 

Disulfiram (Antabuse, 250 to 500 mg daily),  inhibits  the metabolism of acetaldehyde and causes an unpleasant flushing reaction if taken with alcohol. Outcomes of patients who take disulfiram are improved when the drug is taken under supervision.

Pharmacotherapy for Comorbid Conditions : 

Depression and anxiety can precipitate heavy drinking but can also be a result of alcohol abuse. A careful history is required to identify the primary problem. Fluoxetine (Prozac), a selective serotonin reuptake inhibitor, has been found to be effective in decreasing depressive symptoms and the level of alcohol consumption in depressed alcoholics


PROGNOSIS :

The prognosis of alcoholism is poor unless the individual is ready to refrain from such thoughts.Chances of relapse is there which might leads to severe complication.Those alcholics who continues to drink even after the therapy die from alcohol related diseases in the long run,withdrawal symptoms may provoke suicidal thoughts in some indivduals.


PREVENTION :

  • Culture new habbits and hobbies

  • Remaining completely refraining from alcohol in the rest of the life

  • Joining a support group

  • Follow the treatment protocols properly

 


Medicines used in the Treatment :

Medicines used:

  • Naltrexone,

  • Disulfiram and

  • Acamprostate


REFERENCE :

http://medicine news.in

http://elsevier.com

http://ncbi.in

http://cdc.gov.in

http://drugabuse.gov

http://who.in

http://uptodatenews.com