1. Chapter 8: Chronic Alcohol Third leading preventable cause of death in the US

2. Scope of Problem Dependence typically develops after 10-20 years of heavy drinking Dependence typically develops after 10-20 years of heavy drinking Generally once a person has become dependant and stops drinking for a period of time, the physical addiction reasserts itself in a matter of days or weeks. It is rare that the person returns to normal drinking Generally once a person has become dependant and stops drinking for a period of time, the physical addiction reasserts itself in a matter of days or weeks. It is rare that the person returns to normal drinking

3. Binge Drinking Consumption of 5 or more cans of beer or regular mixed drinks during a single episode by someone who is not a daily drinker Consumption of 5 or more cans of beer or regular mixed drinks during a single episode by someone who is not a daily drinker

4. What is the “typical alcoholic? Ideas? Ideas?

5. Symptoms of Alcoholism Tolerance Tolerance Dependence Dependence Craving Craving

6. Tolerance Metabolic: Liver becomes more used to detoxing the alcohol, now takes a person 12 beers instead of 6 beers to feel it Metabolic: Liver becomes more used to detoxing the alcohol, now takes a person 12 beers instead of 6 beers to feel it Behavioral: Novice drinker shows signs of intoxication on a few drinks while the alcoholic walks, talks and functions when very intoxicated Behavioral: Novice drinker shows signs of intoxication on a few drinks while the alcoholic walks, talks and functions when very intoxicated Pharmacodynamic: CNS becomes less sensitive to the alcohol-over time person needs to consume more alcohol for the same effect Pharmacodynamic: CNS becomes less sensitive to the alcohol-over time person needs to consume more alcohol for the same effect

7. Dependence Psychological: find use rewarding, belief that is helps them socialize, relax, sleep better, better sex. Psychological: find use rewarding, belief that is helps them socialize, relax, sleep better, better sex. Physical: withdrawal syndrome is life threatening Physical: withdrawal syndrome is life threatening

8. Craving Preoccupation with alcohol Preoccupation with alcohol Thirsty Thirsty Brain reward system Brain reward system

9. Effects on digestive system Vitamin depletion, robs body of nutrients Vitamin depletion, robs body of nutrients Increased risk for cancers (75% of all esophagus cancer deaths ) Increased risk for cancers (75% of all esophagus cancer deaths ) Liver disease Liver disease Fatty liver: not functioning at full capacity Fatty liver: not functioning at full capacity Alcoholic hepatitis-inflamed, signs are fever, jaundice, enlarger tender liver, dark urine. Very painful. 20-65% will die Alcoholic hepatitis-inflamed, signs are fever, jaundice, enlarger tender liver, dark urine. Very painful. 20-65% will die Cirrhosis: cells die and are replaced by scar tissue, liver functions less, can lead to liver cancer Cirrhosis: cells die and are replaced by scar tissue, liver functions less, can lead to liver cancer Pancreatitis: inflamed Pancreatitis: inflamed

10. Effects on the heart Most physicians do not recommend turning to moderate use of alcohol to reduce risk of heart disease Most physicians do not recommend turning to moderate use of alcohol to reduce risk of heart disease Strokes and Cerebral Vascular Accidents Strokes and Cerebral Vascular Accidents Suppression of cell formation Suppression of cell formation Alcohol induced cardiomyopathy- damage to heart muscles in 25-40% of chronic user Alcohol induced cardiomyopathy- damage to heart muscles in 25-40% of chronic user

11. Effects on CNS Blackouts- alcohol induced amnesia lasting from less than an hour to days. Person appears conscious, talks, walks. Blackouts- alcohol induced amnesia lasting from less than an hour to days. Person appears conscious, talks, walks. Cerebella atrophy-brain cells die causing psychomotor dysfunction (gait & muscles) Cerebella atrophy-brain cells die causing psychomotor dysfunction (gait & muscles) Wernicke’s encephalopathy-severe depletion of thiamine resulting in brain damage. (acute phase of W-Korsakoff) Wernicke’s encephalopathy-severe depletion of thiamine resulting in brain damage. (acute phase of W-Korsakoff) Cont. Cont.

12. Effects on CNS Warnicke-Korsakoff’s syndrome-”wet brain” amnesia, chronic, unable to learn new info, life long neurological damage. Warnicke-Korsakoff’s syndrome-”wet brain” amnesia, chronic, unable to learn new info, life long neurological damage.

13. Effects on mental health Anxiety-10-40% of alcohol dependent Anxiety-10-40% of alcohol dependent Agoraphobia and social phobias usually predate use, self medicate Agoraphobia and social phobias usually predate use, self medicate Many alcohol dependant people get benzodiazepines to control anxiety (10 mg=3-4 drinks)25-50% addicted to benzos Many alcohol dependant people get benzodiazepines to control anxiety (10 mg=3-4 drinks)25-50% addicted to benzos Link between alcohol use d/o and depression Link between alcohol use d/o and depression Use of alcohol interferes with tx for depression Use of alcohol interferes with tx for depression Alcohol dep. People 58-85x more likely to commit suicide. Alcohol dep. People 58-85x more likely to commit suicide.

14. Risk factors of suicide-p.96 Gender Gender Marital Status Marital Status Co-existing depressive d/o Co-existing depressive d/o Adverse life events Adverse life events Recent d/c from treatment for alcoholism Recent d/c from treatment for alcoholism History of suicide attempts History of suicide attempts Biological factors Biological factors

15. Alcohol Withdrawal Life threatening & progressively worse Life threatening & progressively worse Begins 4-12 hrs of last drink or person is trying to cut down (small# w/d 96 hrs-10 days of last drink) Begins 4-12 hrs of last drink or person is trying to cut down (small# w/d 96 hrs-10 days of last drink) Agitation, anxiety, tremors, diarrhea, hyperactivity, exaggerated reflex, insomnia, vivid dreams, nausea, vomiting, sweating, vertigo, headaches, seizures, delirium tremens Agitation, anxiety, tremors, diarrhea, hyperactivity, exaggerated reflex, insomnia, vivid dreams, nausea, vomiting, sweating, vertigo, headaches, seizures, delirium tremens

16. Other complications Head injuries Head injuries TBI from MVA, accidents, violence TBI from MVA, accidents, violence Fetal alcohol syndrome Fetal alcohol syndrome