Alcohol Abuse

Happy Monday, and welcome to Medical Mondays!

I’m apologizing in advance because from here on out, things may get super technical + frighteningly detailed. I’m still making a conscious effort to weed out less pertinent information to you, but…boards are coming up in a couple months and I need to cram a ton of information into my head. This is part of how I’m doing it. :O

On a happier note, I organized my Medical Mondays tab in the header menu into an image gallery of sorts so that posts would be easier to find! :D Feel free to root around through past posts!

In the month I spent on my psychiatry rotation, as well as my away rotation in Family Medicine, I came across a lotttttt of patients who abused alcohol (and/or other substances), and we did a good number of alcohol detoxes with our patients.

April is Alcohol Awareness Month, so I figured I’d start off this month’s Medical Mondays by talking about Alcohol Abuse!

Alcohol Dependence

• One of the most common psychiatric disorders in the U.S., with a prevalence of 8-14%
• Almost always accompanied with a comorbid psychiatric disorder (e.g. drug abuse + antisocial personality disorders in men, anxiety + mood disorders in women)
• Misuse of alcohol often leads to social and legal problems, acts of violence, and accidents, and is associated with over 100k deaths per year.

Although environmental and interpersonal factors can contribute to alcoholism, an important risk factor for developing the disease is to have an alcoholic parent, as there is a genetic predisposition underlying alcoholism.

The U.S. government’s recommended ‘safe’ level for alcohol consumption is:

• Men: 2 drinks per day
• Women: 1 drink per day
• > 65yo: No more than 1 drink per day

*A standard drink is ~12 g alcohol, which equates to a 12 oz. bottle of beer (4.5%), 1 5 oz. glass of wine (12.9%), or 1.5 oz. 80-proof hard liquor.

CAGE Questionnaire

1. Have you ever felt that you should Cut down on your alcohol consumption?
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt bad or Guilty about your drinking?
4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)?

A score of 2 or more is considered to be clinically significant.

Complications

• Alcoholic liver disease
  • Causes progressive liver inflammation + damage from excessive alcohol intake
  • If untreated, liver disease progresses from fatty steatosis (aka you have a fatty liver) to alcoholic hepatitis to eventual liver cirrhosis/fibrosis (irreversible damage)
  • Can lead to cirrhotic complications (e.g. jaundice, hematemesis, portal hypertension, encephalopathy), liver failure, hepatocellular carcinoma (liver cancer), + death
• Alcoholic hallucinosis
  • Seen with alcohol withdrawal (within 12-24 hrs of abstinence)
  • Hallucinations with normal vital signs + normal sensorium
• Delirium tremens (DTs)
  • Life-threatening alcohol withdrawal syndrome that peaks 2-5 days after the last drink
  • Characterized by delirium, seizures, hyperthermia, tachycardia
  • Individuals with DTs are more likely to experience DTs with each subsequent withdrawal period of alcohol withdrawal, with increasingly severe symptoms each time
• Wernicke-Korsakoff syndrome
  • Wernicke’s encephalopathy is classically associated with a triad of confusion, ophthalmoplegia + ataxia
  • Korsakoff’s syndrome progresses from Wernicke’s after continued untreated thiamine deficiency, and can lead to confabulations (filling in gaps in memories with fabrications)
• Mallory-Weiss syndrome
  • Presents as painful hematemesis (bloody vomit) in an alcoholic
  • Longitudinal lacerations of the gastroesophageal junction due to excessive vomiting
• Esophageal varices
  • Presents as painful hematemesis (bloody vomit) in an alcoholic
  • Abnormal, enlarged veins in the lower part of the esophagus, often due to portal hypertension, which can be a consequence of alcohol abuse

Treatment

• Behavioral & Psychosocial
  • Alcoholics Anonymous (AA) + 12-Step Facilitation Therapy
    A free program that follows 12 steps to help alcoholics to work towards their recovery
  • Cognitive-Behavioral Therapy (CBT)
    Teaches patients how to recognize high-risk situations for relapse and how to find healthier ways to cope with cravings and different situations
  • Motivation Enhancement Therapy (MET)
    Counsels patients + motivates them to use their own resources to change their behavior

• Pharmacotherapy
  • Naltrexone (Revia) and acamprosate
    These target different neurotransmitters to reduce cravings and can be used separately or in combination. They have been found to be effective in reducing relapse rates when used with psychosocial therapy. Acamprosate is used widely throughout Europe, and is currently being tested in the U.S.
  • Disulfiram (Antabuse)*
    Best used for highly motivated individuals–disulfiram blocks the action of acetaldehyde dehydrogenase, an enzyme that normally helps to metabolize alcohol in the body; this causes an unpleasant flushing reaction + symptoms when taken with alcohol

*Fun Fact: ~50% Southeast Asians have a genetic variant that makes them deficient in acetaldehyde dehydrogenase, thus causing an unpleasant facial flushing reaction (colloquially termed “Asian glow!”) with tachycardia, nausea, and headaches due to the accumulation of toxic metabolite, acetaldehyde.

So if you’ve ever wondered why I don’t drink alcohol (or why so many Asians seem to turn super red when they drink), this is it!  (I prefer to eat my calories instead of drinking em’ anyway.)

A half-sip of red wine turned me the color of a bunch of overripe tomatoes, and < 0.5 oz. Hypnotiq gave me palpitations, nausea, shortness of breath, and a splitting headache. Basically kinda like I just took some disulfiram. NO THANK YOU. :[

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Disclaimer: This is where I reiterate that I am merely a medical student struggling through the world that is her clinical rotations. The statements made on this blog should not be taken as medical advice to treat, cure or prevent any disease. Please contact your own physician or health care provider before starting a health or fitness/wellness program. (See full disclaimer here.)