Alcohol Abuse

Aka: Alcohol Abuse, Alcohol Dependence, Alcoholism, Problem Drinking

1. See Also
   1. Chemical Dependency
   2. Alcohol Toxicity
   3. Alcohol Withdrawal
   4. Alcohol Detoxification in Ambulatory Setting
2. Epidemiology: General
   1. Lifetime prevalence Alcohol Dependence: 8-14%
   2. Age of symptom onset: 15 to to 19 years
   3. Familial predisposition in autosomal dominant pattern
3. Epidemiology: Alcohol Impaired Driving
   1. Alcohol Impaired Driving Survey (n=102,263)
      1. Overall Alcohol impaired driving in last month: 2.5%
      2. Lowest rate: Women over age 55 years old (0.1%)
   2. Predictors of Alcohol impaired driving
      1. Men aged 21 to 34 years: 7%
      2. Over 4 Alcoholic drinks on 1 occasion in last month
      3. Greater than two Alcoholic drinks per day
   3. States of highest Alcohol impaired driving
      1. Alaska
      2. Nevada
      3. Wisconsin
      4. Michigan
      5. North Dakota
   4. References
      1. Liu (1997) JAMA 277:122-5
4. History: Famous Alcoholics
   1. Sinclair Lewis
   2. Edgar Allen Poe
   3. Dylan Thomas
   4. F. Scott Fitzgerald
   5. Jim Thorpe
5. Pathophysiology
   1. See Addiction Pathophysiology
   2. Substance Abuse or Alcoholism Definition Criteria
      1. Compulsion-Preoccupation
      2. Use despite adverse consequences
      3. Loss of Control
      4. Denial
   3. Mechanism
      1. Limbic System drive state
      2. Alcoholics have lower level of endogenous endorphins
         1. Need TIQs externally from Alcohol to feel normal
   4. Other preparation misued for their Alcohol content
      1. Hand sanitizer (60-85% Alcohol)
      2. Mouthwash
      3. Vanilla extract
6. Physiology: Alcohol Digestion Pathway
   1. One ounce Alcohol takes 1 hour, mouth to excretion
   2. No digestion required before absorption
   3. Small amount absorbed in Stomach
   4. Most Alcohol absorbed in Small Intestine (duodenum)
   5. Metabolism
      1. Alcohol converted to acetaldehyde
      2. Acetaldehyde converted in liver to acetic acid
   6. Excretion
      1. Renal excretion: 10%
      2. Hepatic excretion: 90%
7. History
   1. See Alcoholism Screening
      1. CAGE Questions
      2. NIAAA Quantity and Frequency Questionnaire
   2. See Alcohol Dependence DSM-IV Criteria
   3. See Substance Abuse Evaluation
   4. See medical complications and comorbid conditions below
   5. Alcohol use history (See Grading Alcohol Use)
      1. Drinks per day
      2. Last drink
      3. Binge drinking
   6. Other Illicit Drug use
      1. Marijuana
      2. Cocaine
      3. Heroin
      4. Amphetamines
      5. Benzodiazepine Abuse
      6. Barbiturate Abuse
      7. Quaalude
      8. Hallucinogen
   7. Prior attempts at cessation
      1. Greatest duration of sobriety
      2. Trials of cold turkey
      3. Rehabilitation Programs
      4. Detox Center Admissions
   8. Overuse Complications
      1. Blackouts
      2. Seizures
      3. Hangovers
   9. Accidents
      1. Motor vehicle accidents
      2. Driving while intoxicated (DUI or DWI)
   10. Injuries
       1. Frequent falls or minor trauma
       2. Burns
       3. Violence
   11. Withdrawal complications
       1. See Alcohol Withdrawal
       2. Hallucinations
       3. Delirium Tremens (DT's)
       4. Grand Mal Seizures (GTCS)
8. Evaluation
   1. See Alcoholism Screening
   2. See Substance Abuse Evaluation
   3. See Skin changes suggestive of chemical dependency
   4. See Eye Examination Signs of Chemical Dependency
9. Labs
   1. See Substance Abuse Evaluation
   2. Increased blood Alcohol level or breath analysis
   3. Toxicology Screening for other drug use
   4. Complete Blood Count with increased MCV
      1. Non-megaloblastic Macrocytic Anemia
   5. Lipid panel
      1. Low High Density Lipoprotein
      2. High Triglycerides
   6. Monitoring (labs correlating with increased use)
      1. Gamma glutamyl transferase (GGT)
      2. Carbohydrate-deficient Transferrin
         1. Limited availability
   7. Liver Function Tests
      1. Alkaline Phosphatase
      2. Alanine Aminotransferase (ALT, SGPT)
      3. Aspartate Aminotransferase (AST, SGOT)
10. Comorbid Conditions: Psychiatric Illness
    1. Mood Disorder
       1. Major Depression
       2. Anxiety
          1. Generalized Anxiety Disorder
          2. Panic Attacks
          3. Agoraphobia
          4. Social Phobia
       3. Bipolar Disorder
    2. Schizophrenia
    3. Borderline Personality Disorder
    4. Antisocial Personality Disorder
    5. Other Drug Abuse
       1. Tobacco abuse: >1 pack per day in 70% of Alcoholics
    6. Post-Traumatic Stress Disorder (Veterans)
11. Comorbid Conditions: Infectious disease
    1. Tuberculosis
    2. AIDS
    3. Viral Hepatitis
12. Complications: Medical
    1. Wernicke's Encephalopathy
    2. Korsakoff's Disease
    3. Alcoholic Hepatitis
    4. Cirrhosis
    5. Pancreatitis
    6. Esophageal Varices
    7. Macrocytic Anemia
    8. Peptic Ulcer Disease
    9. Fetal Alcohol Syndrome (children of female Alcoholics)
13. Management
    1. See Alcohol Dependence Management
    2. See Alcohol Withdrawal
    3. See Substance Addiction Aftercare
14. Prognosis: Relapse after CD treatment
    1. Relapse after Treatment in first 3 months: 50%
    2. Relapse after treatment in first 6 months: 80%
    3. Remain sober with Alcoholics Anonymous > 1 year: 76%
15. Resources
    1. See Chemical Dependency Resources
    2. Alcoholics Anonymous
       1. http://www.alcoholics-anonymous.org/
    3. Al-Anon/Ala-Teen (Family and Friends of Alcoholics)
       1. http://www.al-anon.org/
    4. Information from your Family Doctor: Alcohol Abuse
       1. http://www.familydoctor.org/healthfacts/006
16. References
    1. Beddingfeld (July, 1996) Hospital Physician 27-39
    2. (1994) Am Fam Physician 50(8):1737-40
    3. Blondell (1996) Postgrad Med 100(1):69-80
    4. Chang (1995) Am Fam Physician 52(8): 2267-73
    5. Enoch (2002) Am Fam Physician 65(3):441-8
    6. Figueredo (1997) Postgrad Med 101(2):165-76
    7. Gearhart (1991) Am Fam Physician 44(3):907-13
    8. Tobias (1989) Postgrad Med 86(4):67-79