1. Chapter 38
Drug Abuse II: Alcohol 1

2. Alcohol
Most commonly used and abused psychoactive agent in the United States
Some therapeutic use
Primarily used for nonmedical purposes
Moderate consumption (less than 2 drinks/day): prolongs life, reduces risk of dementia and cardiovascular disorders
Excessive consumption: diminishes quality and quantity of life
1 drink= one shot of hard alcohol, one glass of wine, or 1 beer 2

3. Basic Pharmacology of Alcohol
Acute overdose: CNS depression, cardiovascular collapse, respiratory depression
Treatment of acute overdose: gastric lavage and dialysis
Central nervous system effects
Acute effects
General depression of CNS function
Enhances GABA-mediated inhibition
Dose-dependent
Activation of the reward circuit
Binds with 5-HT3 receptors 3

4. Basic Pharmacology of Alcohol
Chronic effects
Two neuropsychiatric syndromes
Wernicke’s encephalopathy- abnormal eye movements, nystagmus- REVERSIBLE WITH THIAMINE
Korsakoff’s psychosis- memory loss, polyneuropathy- IRREVERSIBLE
Impact on cognitive function
Effect on sleep 4

5. Basic Pharmacology of Alcohol
Other pharmacologic effects
Cardiovascular system- acute overdose- vasodilation, chronic use- heart failure, hypertension
Respiration
Liver- fatty liver, hepatits, then cirrhosis
Stomach- gastritis
Pancreas
Cancer: breast and colorectal cancer rates increased
Pregnancy and lactation
Impact on longevity 5

6. Basic Pharmacology of Alcohol
Pharmacokinetics
Absorption
Distribution
Metabolism
Blood levels
Tolerance
Physical dependence- abstinence syndrome is potentially lethal 6

7. Basic Pharmacology of Alcohol
Drug interactions
CNS depressants
Nonsteroidal anti-inflammatory drugs
Acetaminophen- increased risk of liver toxicity
Disulfiram
Antihypertensive drugs 7

8. Basic Pharmacology of Alcohol
Acute overdose
Vomiting, coma, pronounced hypotension and respiratory depression 8

9. Alcohol Use Disorder Relapsing disorder Impaired control over drinking
Preoccupation with alcohol consumption
Use of alcohol despite awareness of adverse consequences
Distortions in thinking
Influenced by genetics and psychosocial and environmental factors 9

10. Drugs for Alcohol Use Disorder
Drugs used to facilitate withdrawal (benzodiazepines)
Drugs used to maintain abstinence (naltrexone, disulfuram, acamprosate)
Other drugs used in the treatment of alcohol abuse 10

11. Drugs Used to Facilitate Withdrawal
Benzodiazepines- these are life-saving for acute severe withdrawal
Chlordiazepoxide (Librium, others)
Diazepam (Valium)
Oxazepam (Serax)
Lorazepam (Ativan)
Adjuncts to benzodiazepines
Carbamazepine (antiepileptic drug)
Clonidine (alpha-adrenergic blocker)
Atenolol and propranolol (beta-adrenergic blockers) 11

12. Drugs Used to Maintain Abstinence
Disulfiram aversion therapy
Refrain from drinking
Causes irreversible inhibition of aldehyde dehydrogenase
Effects caused by alcohol plus disulfiram are referred to as acetaldehyde syndrome
Patients must be CAREFULLY CHOSEN
Patients must be thoroughly informed to avoid all forms of alcohol
Sauces, cough syrups
Alcohol applied to the skin (lotions, colognes, liniments) 12

13. Fig. 38–1. Ethanol metabolism and the effect of disulfiram.13

14. Drugs Used to Maintain Abstinence
Naltrexone (Revia)
Pure opioid antagonist
Decreases craving for alcohol
Blocks reinforcing effects of alcohol
Mechanism unclear
Adverse effects
Nausea
Headache 14

15. Drugs Used to Maintain Abstinence
Acamprosate (Campral)
Reduces unpleasant feelings brought on by abstinence
Devoid of direct anxiolytic, anticonvulsant, and antidepressant activity
Does not cause alcohol aversion
Administered orally
Excreted unchanged in the urine
Adverse effects and drug interactions
Diarrhea
Avoid during pregnancy 15

16. Nutritional Support, Fluid Replacement, and Antibiotics
B vitamins
Thiamine
Folic acid
Cyanocobalamin
Vitamin supplements
Fluid replacement therapy
Antibiotics 16