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alcohol - introduction 1 introduction ALCOHOL & ALCOHOL PROBLEM 신 신 신 Dept. of Psychiatry Yonsei Univ. Wonju Medical Co llege

Alcohol - introduction1 introduction ALCOHOL & ALCOHOL PROBLEM 신 정 호 Dept. of Psychiatry Yonsei Univ. Wonju Medical College

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  • Slide 1
  • alcohol - introduction1 introduction ALCOHOL & ALCOHOL PROBLEM Dept. of Psychiatry Yonsei Univ. Wonju Medical College
  • Slide 2
  • 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
  • Slide 3
  • 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
  • Slide 18
  • 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. : / ,
  • Slide 23
  • 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
  • Slide 25
  • 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 ( )
  • Slide 28
  • 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
  • Slide 29
  • 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
  • Slide 30
  • 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
  • Slide 31
  • alcohol - introduction31 -
  • Slide 32
  • 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 ____________________________________________________________ non-addictive addictive high addictive very high secondary killer secondary killer secondary killer primary 'killer