Post on 21-Dec-2015
Alcoholism and Substance Abuse
Focus
Alcoholism
Phenomenology
Definitions 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 potencycontinued usehigher doses are needed for same effect.
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 termsSubstance dependenceSubstance Abuse
Epidemiology
Substance Use
0
20
40
60
80
100
Alcohol
Caffeine
Tobacco
Illic it
Alcohol Dependence
Very commonECA: ~14%> 10 million Americans
Another 8 million “problem drinkers”Only 3% “skid row”
Epidemiology: Illicit Abuse (%)
0
2
4
6
8
10
12
14
Alcohol
Amphet
Cannabis
Cocaine
Hallucin.
Opioids
Tranquilizers
Alcohol Dependence
Gender >>
Probably 2 types
Alcohol Dependence: Age
More common in adults, but...Teenage also common
15% HS 5+ drinks/occasion/week31% HS intoxicated 6+/year
Under-Dx in elderly♂: alcohol♀: look for prescription drugs
Alcohol Dependence: Social Factors
More commonRuralUndereducated
Low socioeconomicLess likely to drinkMore likely to abuse
Alcohol Dependence: Socioeconomics
Associated withUnstable marriages
Increase risk divorce 3XUnstable work
Alcohol Dependence: Medical Ramifications
20-50% hospital admissionsMay be unrecognized
~20% ER visits
80% of cirrhosis
33% of suicides
Pathology
Pathology of
Acute PhysiologicalToleranceWithdrawal
Addiction
Etiology
Etiology of Substance Abuse: Genetics
1 parent: 20%
2 parents 20-50%
sons of father50% if severe alcoholic and criminal:
90% risk in son.
Genetics
Twins fraternal:28% identical: 54%
AdoptedDanish Adoption Study (1974)
adopted sons of alcoholics raised by non-alcoholic foster parents still had increased risk of alcoholism.
Social Influences
Diagnosis
DiagnosisSubstance Dependence
Maladaptive pattern of substance use
3 or more (1 year): Tolerance Withdrawal larger amounts Desire/Cut down Time spent Activities Continued use
DiagnosisSubstance Abuse
Maladaptive pattern 1 (1 year) recurrent use failed obligationshazardous useLegal problemsContinued use despite causing
interpersonal or social problems. R/O: Substance dependence
Other Diagnoses
Substance Intoxication
Substance Withdrawal
Diagnoses:Other substances
Alcohol Amphetamines and related Caffeine Cannabis Cocaine Hallucinogens Inhalants Nicotine Opioids Phencyclidine and related Sedatives
Polysubstance Abuse ( 3) Other
Diagnosis
Other Schemas for AlcoholGreek lettersTypologies
Diagnosis
CAGE QuestionnaireHave you ever felt the need to Cut down on
drinkingHave you ever felt Annoyed by criticisms of
drinkingHave you ever had Guilty feelings about
drinkingHave you ever taken a morning Eye opener
Diagnosis
CluesHistoryPhysicalLabs
Differential
Normal useWhat’s normal?
Comorbid Disorders and Complications
Alcohol WithdrawalUncomplicatedSeizuresHallucinosisDT’s
Comorbid Disorders and Complications
Comorbid Medical Disorders Comorbid Psychiatric Illnesses
Course
Relapses and remission
PredictorsGenderAge of onsetFamily history