Alcohol - introduction1 introduction ALCOHOL & ALCOHOL PROBLEM 신 정 호 Dept. of Psychiatry...
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- alcohol - introduction1 introduction ALCOHOL & ALCOHOL
PROBLEM Dept. of Psychiatry Yonsei Univ. Wonju Medical College
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- alcohol - introduction2 u major human beverage u diet, source
of calories u concentration by distillation u reformation,
temperance, prohibition u portable nonalcoholic beverage: boiled
water, coffee, tea u purification, sanitation of water
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- alcohol - introduction3 Problem drinker: prevalence: 10%/m,
3-5%/w Health problem heart>cancer> alcohol-related illness
Death: 0.2m/y, 1st cause of young adult death drunken driving: 50%
of fatal car accident Woman with alcohol: 1st cause of mental
retard Expenditure Death: homicide: 50%, suicide: 25% Life
expectancy
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- alcohol - introduction4 u abuse( ) u harmful use u dependence(
) physical psychic, psychological u tolerance( ) u addiction( ) u
habituation( ) u withdrawal, abstinence( )
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- alcohol - introduction5 ? acute alcohol intoxication defined by
driving (BAC) - 70mg/100ml. White liquor: 180cc Gin, Whisky: 100cc
Beer: 1liter Wine: 400cc
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- alcohol - introduction6 0 % .03 % .05 % ( ).07 % .15 % .40 %
.60 %
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- alcohol - introduction7 alcoholism, alcohol dependence 20~40%
of all hospital admission 4th cause of death in men(25~44y)
accident, homicide, suicide, liver cirrhosis medical cost >
respiratory illness + cancer.
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- alcohol - introduction8 Substance-related Disorders u Substance
use disorder u Substance induced disorder
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- alcohol - introduction9 Substance-related Disorders u
dependence( ) u abuse( ) u intoxication( ) u withdrawal( ) u
intoxication delirium( ) u withdrawal delirium( ) u dementia( ) u
amnestic disorder( ) u psychotic disorders( ) u mood disorders( ) u
anxiety disorders( ) u sexual dysfunctions( ) u sleep disorders(
)
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- alcohol - introduction10 u Hallucinogens( ) u psychostimulants(
) u opioids( ) u sedatives, hypnotics( )
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- alcohol - introduction11 Substance Alcohol Amphetamine Caffeine
Cannabis Cocaine Hallucinogens Inhalants Nicotine Opioids
Phencyclidine Sedatives
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- alcohol - introduction12 Alcohol-related Disorders (DSM IV) (1)
Alcohol Use Disorders (2) Alcohol Induced Disorders
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- alcohol - introduction13 (1) Alcohol Use disorders Alcohol
dependence Alcohol abuse
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- alcohol - introduction14 (2) Alcohol Induced Disorders Alcohol
intoxication - intoxication delirium Alcohol withdrawal -
withdrawal delirium Alcohol-induced persisting dementia
Alcohol-induced persisting amnestic disorder Alcohol-induced
psychotic disorder, with delusion Alcohol-induced psychotic
disorder, with hallucination Alcohol-induced mood disorders
Alcohol-induced anxiety disorders Alcohol-induced sexual
dysfunctions Alcohol-induced sleep disorders
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- alcohol - introduction15 1/3 Alcohol X X X X I Amphetamine X X
X X I Caffeine X Cannabis X X X I Cocaine X X X X I Hallucinogens X
X X I Inhalants X X X I Nicotine X X Opioids X X X X I
Phencyclidine X X X I Sedatives X X X X I
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- alcohol - introduction16 2/3 Alcohol W P P I/W Amphetamine I
Caffeine Cannabis I Cocaine I Hallucinogens I Inhalants P I
Nicotine Opioids I Phencyclidine I Sedatives W P P I/W
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- alcohol - introduction17 3/3 Alcohol I/ W I/W I I/W Amphetamine
I/W I I I/W Caffeine I I Cannabis I Cocaine I/W I/W I I/W
Hallucinogens I I Inhalants I I Nicotine Opioids I I I/W
Phencyclidine I I Sedatives I/W W I I/W
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- alcohol - introduction18 1. (20%) 2. (30%)
- alcohol - introduction19 (men over 12y) u current alcohol user
52 % at least 1 drink / past month u binge drinking 15.8% >5
drinks on the same occasion >1 day / past month u heavy drinking
5.5% >5 drinks on the same occasion >5 days / past month
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- alcohol - introduction20 N = 400 I abstainer 20% II moderate
drinker 1 - 13 drinks/week 21% III 2 - 3 drinks/day 12% heavy
drinker IV 3 - 4 drinks/day 11% V problem drinker ( 2-3 PDS) 9% VI
alcohol abuse < 5 years 4% VII alcohol abuse > 5 years
23%
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- alcohol - introduction21 problem drinking scale (PDS) Employer
complaints Multiple job losses Family/friends complaints Marital
problem Medical problem Diagnosis by clinician Alcohol-related
arrest Hospital, clinic, or AA visit >2 blackouts Going on wagon
Morning tremulousness/drinking Tardiness or sick leave Admits
problem with control
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- alcohol - introduction22 1. : 2. : 4 / , , , 3. : 1 / , / , ,
4. : 1,2 / , / / , , / 5. : , / , , / 6. : / ,
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- alcohol - introduction23 ( ) (DSM IV) maladaptive pattern of
use, leading impairment or distress, >3 in 12 m 1. tolerance 2.
withdrawal 3. larger amount or longer period 4. persistent but
unsuccessful effort to cut down 5. time spent to get, use, recover
6. no important social, job, recreational activity 7. physical and
psychological problem
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- ? chronic progressive fatal disease with a high potential for
relapse behavioral and cognitive disorder maintained by a faulty
core belief system personality disorder: antisocial, dependent,
borderline, etc
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- alcohol - introduction25 u childhood history u psychodynamic
factor u social, cultural factor u behavioral, learning factor u
genetic, other biological factor
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- alcohol - introduction26 ,
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- reactive grandiosity ( )
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- alcohol - introduction28 1 "I CANT DRINK." detoxification
(external control) antabuse, anticraving directive psychotherapy
family therapy, A.A. 2 "I WONT DRINK. A.A. (internalized control)
directive psychotherapy supportive psychotherapy 3 "I DONT HAVE TO
DRINK." (conflict resolution) analytic psychotherapy
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- alcohol - introduction29 (PDS) denial all-or-none thinking
rationalization projection conflict minimization and avoidance
self-centered selective attention non-analytic mode of thinking
& perceiving passivity vs assertion obsessional focusing
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- founded in May 1990 well-motivated semi-open aftercare group
unique expanded, extended eclectic model: intensive inpatient
individual psychotherapy follow-up outpatient group
cogno-behavioral, family therapy inpatient program goal: ability to
receive outpatient follow-up care
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- alcohol - introduction31 -
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- alcohol - introduction32 HALLUCINOGEN STIMULANT OPIOID SEDATIVE
mind expander' 'upper' 'dreamer' 'downer marijuana cocaine opium
valium LSD philopon morphine ativan PCP nicotine demerol seconal
mescaline methadone luminal codeine alcohol
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non-addictive addictive high addictive very high secondary killer
secondary killer secondary killer primary 'killer