Medical Consequences of Alcohol and Drug Use Disorders
Eric B. Raimo, M.D.
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www.alcoholmedicalscholars.org
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Overview
• Acute effects • Chronic heavy use
• Withdrawal
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Epidemiology
• 20-40% hospital admissions • Outpatient setting
• 100,000 deaths per year
• Alcoholics who continue drinking have a shortened life-span of 15 years
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Acute Effects
• CNS
– accidents
• Gastrointestinal
• Respiratory
– overdose
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Overview
• Acute effects • Chronic heavy use
• Withdrawal
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Effects of Chronic Heavy Drinking
• CNS
– Neuropathies – Cerebellar degeneration – Dementia – Wernicke-Korsakoff’s syndrome
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Effects of Chronic Heavy Drinking
• Gastrointestinal
– Alimentary/stomach – Liver – Pancreas
• Cardiovascular
– Hypertension – Cardiomyopathy – Stroke
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Effects of Chronic Heavy Drinking
• Reproductive
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Effects of Chronic Heavy Drinking
• Hematologic • Musculoskeletal • Endocrine • Dermatologic
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Biological Markers of Chronic Heavy Drinking
• GGT (>30)
• CDT (>20) • MCV (>90)
• AST/ALT
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Overview
• Acute effects • Chronic heavy use
• Withdrawal
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Withdrawal Effects
• Rule of thumb:
–Withdrawal effects are opposite of intoxication sx/signs
• Alcohol withdrawal
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Alcohol-Drug Interactions
• Illicit drugs (e.g., cocaine, heroin) • Prescription drugs (e.g., benzodiazepines, metronidazole) • Over-the-counter drugs (e.g., acetaminophen)
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Rx
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Fetal Alcohol Syndrome
• Growth retardation
• Facial dysmorphism
• Severe CNS dysfunction
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Moderate Alcohol Use
• Cardiovascular
• Gallstones
• Other potential beneficial effects
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Summary
• Alcohol can be medically hazardous acutely, with chronic high levels of use, and in withdrawal
• Every major organ system is affected
• Morbidity and mortality
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Marijuana
• Motor vehicle accidents • Learning • Respiratory
• Immune system
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Stimulants (Cocaine and Amphetamine)
• Cardiovascular • Neurological • Injection risks
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Opioids
• Overdose • Injection risks • Gastrointestinal
• Musculoskeletal
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Other Drugs
• PCP
• Inhalants
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Summary
• Alcohol and drugs of abuse are physically hazardous • Medical consequences are associated intoxication, chronic heavy use, and withdrawal • Specific drugs affect major organ systems differently • Morbidity and mortality
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