Alcohol Use Disorder

Alcohol Use Disorder
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What Is Alcohol?

It is a toxic and volatile psychoactive substance produced after natural fermentation of sugars with severe dependence producing properties.

It is the intoxicating constituent of wine, beer and other drinks.

Ethyl is the most common form of alcohol present in drinks and beverages in varying quantities.

Which names do we call alcohol in Kenya?

  • Tembo
  • Mvinyo
  • Tei
  • Maji
  • Keroro
  • Gauge
  • Ndogogio
  • Kamnyweso
  • Karubu
  • Booze
  • Brew

Epidemiology

Globally: It is estimated that about 2 billion people consume alcohol. Of this 76 million are dealing with alcohol use disorder.

In Africa: The consumption rate is estimated to be about 6.4 liters per day per person older than 45 years.

In Kenya: 12.2% of persons aged between 15 and 65 or about 3.3million are active alcohol users, 10.4% of them being addicted.

Statistics:

  • 4% (508,132) students had at some point consumed alcohol.
  • Gender: male > women
  • Education: higher on colleges and universities.
  • Age: youth more than adults.

What are the short time effects….?

  • Lowered inhibitions, leading to poor social judgment.
  • Trouble concentrating.
  • Loss of coordination.
  • Loss of critical judgment.
  • Dulled perception, especially vision.
  • Mood swings.
  • Reduced core body temperature.
  • Raised blood pressure.
  • Passing out.

Long term effects

  • Reduced brain size.
  • Memory loss.
  • Loss of attention span.
  • Trouble learning.
  • Alcoholic hepatitis.
  • Formation of scar tissue in the liver (liver fibrosis).
  • Liver may contain a lot of fat. i.e. fatty liver.
  • Throat, mouth, larynx, breast, liver, colorectal, or esophageal cancer.
  • High blood pressure
  • Stroke
  • Irregular heart beat

Alcohol Overdose

Alcohol overdose (alcohol poisoning) is a medical emergency with serious and sometimes deadly consequence of drinking large amounts of alcohol in a short period of time.

Occurs when you drink too much alcohol than what your liver can metabolize.

The body can safely process around one unit (10ml) of pure alcohol per hour.

Signs and symptoms of alcohol overdose

  • Pale or blue skin
  • Decrease in body temperature (hypothermia)
  • Passing out (unconsciousness)
  • Slowing or stopping breathing and heart rate, both of which are controlled by the nervous system
  • Cardiac arrest following a decrease in the body’s temperature (hypothermia)
  • Seizures as a result of low blood sugar levels

DSM V Definition Of Alcohol Use Disorder

It is a dysregulated pattern of substance use leading to clinically significant impairment or distress.

The presence of at least two (2) of the following symptoms occurring at any time over a period of twelve (12) months indicates Alcohol Use Disorder (AUD)

  1. Alcohol is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
  3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
  4. Craving, or a strong desire or urge to use alcohol.
  5. Recurrent use resulting to the inability to fulfill major role obligations.
  6. Continued use despite having persistent or recurrent social or interpersonal problems caused or made worse by the effects of alcohol.
  7. Important social, occupational, or recreational activities are stopped or reduced because of alcohol use.
  8. Recurrent alcohol use in situations in which are physically hazardous.
  9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or made worse by alcohol.

Classification according to DSM V

It is classified as

  1. Mild : The presence of 2 to 3 symptoms
  2. Moderate   : The presence of 4 to 5 symptoms
  3. Severe        : The presence of 6 or more symptoms

Management of Alcohol Overdose

  • Alcohol overdose is typically treated in the emergency room. Monitor vital signs, i.e. heart rate, blood pressure, and temperature.
  • Fluids or medications provided through a vein (intravenously).
  • Supplemental oxygen provided through a mask or tube inserted in the nose to patients who have breathing difficulties.
  • Nutrients (such as thiamin or glucose) to prevent additional complications of alcohol poisoning, such as brain damage.
  • Medications to stop the seizure activity.

What Is Alcohol Addiction?

A chronic disease characterized by uncontrolled drinking and preoccupation with alcohol.

It is the inability to control drinking due to both a physical and emotional dependence on alcohol.

It is the repeated alcohol consumption despite related legal and health issues. They may begin each day with a drink, feel guilty about their drinking and have the desire to cut down on the amount of drinking.

Signs and symptoms of alcohol addiction.

  • Nausea and vomiting
  • Diaphoresis
  • Agitation and anxiety
  • Headache
  • Tremor
  • Seizures
  • Visual and auditory hallucinations: Many patients who are not disoriented—and who therefore do not have delirium tremens—have hallucinations
  • Increased heart rate and hypertension
  • Temperature elevation.
  • Shaking and uncontrolled shivering.
  • Enlarged breast tissue in males.
  • Swollen blood vessels under the skin.
  • Shrinking of the testes.
  • Enlarged or shrunken liver.
  • Enlarged spleen.

Investigations for alcohol overdose

Liver function test

Aspartate aminotransferase (AST) will be > 1.5 more than ALT value

Alanine aminotransferase (ALT)

Elevated Gamma glutamyltransferase (GGT)

Full haemogram

Mean corpuscular volume (MCV) is elevated

Breathalyzer (Alco blow)

Sober        : 0.0% blood alcohol content(BAC).

Legally intoxicated: 0.08% BAC

Very impaired: 0.08–0.40% BAC.

At risk for serious complications: Above .40% BAC.

Management of alcohol addiction

It’s worthy noting that only Patients with serious withdrawal symptoms qualify for medical management while the asymptomatic ones only benefit from non-pharmacological management.

Management is categorized into:

Non-pharmacological

Pharmacological

Non-pharmacological

  • Abstinence
  • Strongly recommending Alcohol anonymous
  • Attending Alcohol anonymous meetings meetings
  • Change in social activities e.g., avoiding bars, changing friends
  • psychotherapy

What Is Alcohol Anonymous?

It is a nonprofessional, self-supporting, multiracial, apolitical, global fellowship of men and women who have had a drinking problem, who meet and share their experience with the hope of helping each other solve their common problem.

There are no other requirements to joining Alcohol anonymous other than having a desire to quit drinking,

12 steps of alcohol anonymous

  1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
  2. Came to believe that a Power greater than ourselves could restore us to sanity.
  3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
  4. Made a searching and fearless moral inventory of ourselves.
  5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
  6. Were entirely ready to have God remove all these defects of character.
  7. Humbly asked Him to remove our shortcomings.
  8. Made a list of all persons we had harmed, and became willing to make amends to them all.
  9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
  10. Continued to take personal inventory and when we were wrong promptly admitted it.
  11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
  12. Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Benefits of alcohol anonymous

  • Free meetings.
  • No obligation to join.
  • No intrusive questions.
  • You can retain anonymity.
  • Creates a network of support.
  • Open to everyone.

Alcohol anonymous locations in Kenya

  • Holy Family Basilica Nairobi.
  • All Saints Cathedral Nairobi.
  • Consolata Church Westlands.
  • Hekima University College.
  • Madre Teresa Catholic Church Zimmerman.
  • Mavuno in Athi River.
  • Igoji Catholic Church Meru.
  • Mombasa Hospital sisters’ mess.
  • Nakuru Central SDA Church.
  • St Peters The Rock, Thika.
  • The Chapel Nanyuki.

Pharmacological

  • Benzodiazepines e.g. Lorazepam and oxazepam
  • B blockers e.g. atenolol, propranolol
  • Clonidine used in management of ADHD
  • Phenoziazines e.g. chlorpromazine, fluphenazine, prochlorperazine
  • Anticonvulsants e.g. carbamazepine, diazepam, phenytoin
  • Disulfiram (antabuse) together with psychotherapy has reduced risk of relapse
  • Naltrexone –blocks opiate receptors thus decreasing alcohol craving

Psychotherapy in Alcohol Abuse Management

Focuses on thoughts and behaviors

Two major theories of substance abuse are used

  1. Relapse prevention
  • Identification of risk situations.
  • Understanding chain of decisions leading to abuse.
  1. Cognitive therapy
  • Positive and negative drug related beliefs and spontaneous flashes relating to drug and substance abuse.

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