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