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Introduction to Diagnosis and Treatment of Alcoholism

VIEWS: 109 PAGES: 18

  • pg 1
									An Introduction to
Diagnosis and
Treatment of
Alcoholism
 Marc A. Schuckit, M.D.




              Copyright Alcohol Medical Scholars Program   1
Alcohol Prevalence
   90% Ever drank
   60% Current drinkers
   >40% Temporary problems
   10-20% Abuse
   3-10% Dependence




       Copyright Alcohol Medical Scholars Program   2
YEARLY COSTS IN US
$300 Billion Overall
  $71 Billion Direct Costs
22,000 Deaths + 2,000,000 Injuries
4,600,000 Damaged Vehicles
15% - 25% Healthcare Budget
  90% of Liver Disease
  72% of Pancreatitis
  41% of Seizure Disorders
  13% Breast Cancers
         Copyright Alcohol Medical Scholars Program   3
                DSM-IV Dependence

1. Tolerance*
2. Withdrawal*
3. Larger amounts/longer period than intended
4. Inability to, or persistent desire to, cut down
   or control
5. A great deal of time spent obtaining, using, or
   recovering
6. Important activities given up or reduced
7. Use despite problems caused or exacerbated by use

*Dx: “with Physiological Dependence”
                 Copyright Alcohol Medical Scholars Program   4
            DSM-IV Abuse

1. Failure to fulfill major role obligations
2. Use in hazardous situations
3. Legal Problems
4. Use despite problems




             Copyright Alcohol Medical Scholars Program   5
Alcoholism Natural History
Event                                         Age
1st drink                                     13
1st drunk                                     15
1st problem                                   18
1st dependence                               25-40
Death                                         60




       Copyright Alcohol Medical Scholars Program    6
Alcoholism Course
  •Fluctuating:
     controlled use
     problems
     abstinence
  •20% spontaneous remission



      Copyright Alcohol Medical Scholars Program   7
        Dual Diagnosis
 2/3 Have Psych. Dx
 1/3 Axis I
 Most are Substance Induced Disorders
 Schiz., MDD, ASPD Risk
 Use a Timeline



         Copyright Alcohol Medical Scholars Program   8
         TIMELINE


B                                                   40
 Age Onset Dependence
 Ages 3+ mo. Abstinence
 Ages of Major Disorder



       Copyright Alcohol Medical Scholars Program        9
 Ask All Patients
About Problems In:
       •Relationships
       •School or job
       •Accidents
       •Arrests
       •Health
THEN tie in substances




 Copyright Alcohol Medical Scholars Program   10
State Markers •GGT > 30
                      •MCV > 91
                       •CDT < 20
               •+UA; Lipids; etc.
                •Questionnaires:
                             MAST
                             CAGE




        Copyright Alcohol Medical Scholars Program   11
POSSIBLE BRIEF SELF-ADMINISTERED
 QUESTIONNAIRES FOR SCREENING
       ALCOHOL PROBLEMS

 1. 4 Item CAGE
 2. 5 Item TWEAK
 3. 25 Item Michigan Alcohol
    Screening Test (MAST)
 4. 10 Item Alcohol Use Disorders
    Identification Test (AUDIT)
           Copyright Alcohol Medical Scholars Program   12
Stages of Treatment
  Identification
  Detoxification
     Physical exam and history
     Vitamins
     Reassurance
     + Benzodiazepines
  Rehabilitation
     Enhance motivation
     Help readjust to life
     Relapse Prevention
     + Medications
  Aftercare
   Copyright Alcohol Medical Scholars Program   13
 Withdrawal

Autonomic dysfunction - Insomnia -
  Anxiety

* Begin 8+ hours           * Diminish at day 5
* Peak at day 2            * Disappear 3 - 6 months




          Copyright Alcohol Medical Scholars Program   14
Treatment of Withdrawal
  Physical examination
  Supports
  Vitamins
  CNS depressants




     Copyright Alcohol Medical Scholars Program   15
Rehabilitation
       Increase motivation
       Help rebuild life
    Relapse                Prevention
       +/- medications




        Copyright Alcohol Medical Scholars Program   16
         Alcohol Rehab

? Naltrexone
? Acamprosate
? Disulfiram
? SSRI                   Not:
? Buspirone              LI, Anti-depressants,
                         Other




         Copyright Alcohol Medical Scholars Program   17
         GENETICS

 Familial
 MZ > DZ
 4x Risk, Even if Adopted
 LR Predicts Risk




       Copyright Alcohol Medical Scholars Program   18

								
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