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Alcohol Abuse
Aka: Alcohol Abuse, Alcohol Dependence, Alcoholism, Problem Drinking, Alcohol Use Disorder, Alcoholism Complications, Vitamin Deficiency in Alcoholism
- See Also
- Chemical Dependency
- Alcohol Toxicity
- Alcohol Withdrawal
- Alcohol Detoxification
- Alcohol Detoxification in Ambulatory Setting
- Epidemiology: General
- Lifetime prevalence Alcohol Dependence: 8-14%
- Age of symptom onset: 15 to to 19 years
- Familial predisposition in Autosomal Dominant pattern
- Epidemiology: Alcohol Impaired Driving
- Alcohol Impaired Driving Survey (n=102,263)
- Overall alcohol Impaired Driving in last month: 2.5%
- Lowest rate: Women over age 55 years old (0.1%)
- Predictors of alcohol Impaired Driving
- Men aged 21 to 34 years: 7%
- Over 4 Alcoholic drinks on 1 occasion in last month
- Greater than two Alcoholic drinks per day
- States of highest alcohol Impaired Driving
- Alaska
- Nevada
- Wisconsin
- Michigan
- North Dakota
- References
- Liu (1997) JAMA 277:122-5 [PubMed]
- History: Famous Alcoholics
- Sinclair Lewis
- Edgar Allen Poe
- Dylan Thomas
- F. Scott Fitzgerald
- Jim Thorpe
- Pathophysiology
- See Addiction Pathophysiology
- Substance Abuse or Alcoholism Definition Criteria
- Compulsion-Preoccupation
- Use despite adverse consequences
- Loss of Control
- Denial
- Mechanism
- Alcohol increases activity at GABA Receptors with secondary CNS depression
- Chronic Alcohol use down regulates GABA Receptors and up regulation of NMDA receptors
- Alcohol Withdrawal results in excessive excitation
- Limbic System drive state
- Alcoholics have lower level of endogenous endorphins
- Need TIQs externally from Alcohol to feel normal
- Other preparation misued for their Alcohol content
- Mouthwash
- Vanilla extract
- Ethanol-based hand sanitizer (especially in health care centers)
- Small ingestions of hand sanitizer can cause significant Alcohol Intoxication (>60% Alcohol)
- Some users extract the Alcohol content with salt
- Physiology: Alcohol Digestion Pathway
- One ounce Alcohol takes 1 hour, mouth to excretion
- No digestion required before absorption
- Small amount absorbed in Stomach
- Most Alcohol absorbed in Small Intestine (duodenum)
- Metabolism
- Alcohol converted to acetaldehyde
- Acetaldehyde converted in liver to acetic acid
- Excretion
- Renal excretion: 10%
- Hepatic excretion: 90%
- History
- See Alcoholism Screening
- AUDIT-C (or full AUDIT tool, or single question screening)
- CAGE Questions
- NIAAA Quantity and Frequency Questionnaire
- See Alcohol Use Disorder Diagnosis
- See Substance Abuse Evaluation
- See medical complications and comorbid conditions below
- Alcohol use history (See Grading Alcohol Use)
- Drinks per day
- Men: >2 per day (>14/week) suggests Alcohol Dependence
- Women: >1 per day (>7/week) suggests Alcohol Dependence
- Last drink
- Binge drinking
- Men: >5 drinks on single occasion in last year suggests Alcohol Dependence
- Women: >4 drinks on single occasion in last year suggests Alcohol Dependence
- Other Illicit Drug use
- Marijuana
- Cocaine
- Heroin
- Amphetamines
- Benzodiazepine Abuse
- Barbiturate Abuse
- Quaalude
- Hallucinogen
- Prior attempts at cessation
- Greatest duration of sobriety
- Trials of cold turkey
- Rehabilitation Programs
- Detox Center Admissions
- Overuse Complications
- Blackouts
- Seizures
- Hangovers
- Accidents
- Motor Vehicle Accidents
- Driving while intoxicated (DUI or DWI)
- Injuries
- Frequent falls or minor Trauma
- Burns
- Violence
- Withdrawal complications
- See Alcohol Withdrawal
- Hallucinations
- Delirium Tremens (DT's)
- Grand Mal Seizures (GTCS)
- Evaluation
- See Alcoholism Screening
- See Substance Abuse Evaluation
- See Skin changes suggestive of chemical dependency
- See Eye Examination Signs of Chemical Dependency
- Labs
- See Substance Abuse Evaluation
- Increased blood Alcohol level or breath analysis
- Toxicology Screening for other drug use
- Complete Blood Count with increased MCV
- Non-megaloblastic Macrocytic Anemia
- Lipid panel
- Low High Density Lipoprotein
- High Triglycerides
- Monitoring (labs correlating with increased use)
- Gamma glutamyl transferase (GGT)
- Carbohydrate-deficient Transferrin
- Limited availability
- Liver Function Tests
- Alkaline Phosphatase
- Alanine Aminotransferase (ALT, SGPT)
- Aspartate Aminotransferase (AST, SGOT)
- Comorbid Conditions: Psychiatric Illness
- Mood Disorder
- Major Depression
- Anxiety
- Generalized Anxiety Disorder
- Panic Attacks
- Agoraphobia
- Social Phobia
- Bipolar Disorder
- Schizophrenia
- Borderline Personality Disorder
- Antisocial Personality Disorder
- Other Drug Abuse
- Tobacco Abuse: >1 pack per day in 70% of Alcoholics
- Post-Traumatic Stress Disorder (Veterans)
- Comorbid Conditions: Infectious disease
- Tuberculosis
- AIDS
- Viral Hepatitis
- Complications: Medical
- Korsakoff's Disease
- Alcoholic Hepatitis
- Cirrhosis
- Pancreatitis
- Esophageal Varices
- Macrocytic Anemia
- Peptic Ulcer Disease
- Fetal Alcohol Syndrome (children of female Alcoholics)
- Complications: Vitamin Deficiency
- Vitamin A Deficiency (Retinol Deficiency)
- Presents with night blindness
- Vitamin C Deficiency (Scurvy)
- Presents with Bleeding Gums, Fatigue
- Vitamin B1 Deficiency (Thiamine deficiency, Wernicke's Encephalopathy)
- Presents with Ataxia, Confusion, Ophthalmoplegia (lateral Gaze Palsy)
- Vitamin B3 Deficiency (Niacin Deficiency, Pellegra)
- Presents with Diarrhea, dermatitis and Dementia (3 D's)
- Vitamin B6 Deficiency (Pyridoxine deficiency)
- Presents with Glossitis, Peripheral Neuropathy
- Vitamin B9 Deficiency (Folic Acid Deficiency)
- Presents with Macrocytic Anemia (also caused by B12 Deficiency)
- Vitamin B12 Deficiency (Cobalamin Deficiency, Pernicious Anemia)
- Presents with weakness, Peripheral Neuropathy, Ataxia, Dementia, macroyctic Anemia
- References
- Jhun et al. in Herbert (2016) EM:Rap 16(9): 8-10
- Management
- See Alcohol Dependence Management
- See Alcohol Withdrawal
- See Substance Addiction Aftercare
- Prognosis: Relapse after CD treatment
- Relapse after Treatment in first 3 months: 50%
- Relapse after treatment in first 6 months: 80%
- Remain sober with Alcoholics Anonymous > 1 year: 76%
- Resources
- See Chemical Dependency Resources
- Alcoholics Anonymous
- http://www.aa.org/
- Al-Anon/Ala-Teen (Family and Friends of Alcoholics)
- http://www.al-anon.org/
- Information from your Family Doctor: Alcohol Abuse
- http://www.familydoctor.org/healthfacts/006
- References
- Beddingfeld (July, 1996) Hospital Physician 27-39
- (1994) Am Fam Physician 50(8):1737-40 [PubMed]
- Blondell (1996) Postgrad Med 100(1):69-80 [PubMed]
- Chang (1995) Am Fam Physician 52(8): 2267-73 [PubMed]
- Enoch (2002) Am Fam Physician 65(3):441-8 [PubMed]
- Figueredo (1997) Postgrad Med 101(2):165-76 [PubMed]
- Gearhart (1991) Am Fam Physician 44(3):907-13 [PubMed]
- Tobias (1989) Postgrad Med 86(4):67-79 [PubMed]
- Winslow (2016) Am Fam Physician 93(6): 457-65 [PubMed]