Alcohol abuse symptom diagnosis management and treatment

Alcohol abuse and dependence
Definition

image are come from google image

Regular or binge consumption of alcohol sufficient to
cause physical, neuropsychiatric or social damage.
Incidence/prevalence
3–4%of the population report alcohol-related problems

Aetiology

Various factors have been implicated:
Genetic factors: Evidence includes variation across
racial groups and twin studies.
Psychiatric factors: Family history of depression, increased
risk in the presence of chronic psychiatric and
physical illness especially pain.
Social factors: Occupation, cultural and peer group
pressure
Clinical features
Alcohol abuse and alcohol dependence are classified as
recognisable entities.
Alcohol abuse is a drinking pattern associatedwith social
compromise such as work or school absenteeism,
legal problems related to alcohol use, or continued alcohol
use despite causing social or relationship problems.
Alcohol dependence is defined as a maladaptive pattern
of use associated with tolerance and withdrawal
syndrome despite significant physical and psychological
problems. Patients often exhibit a stereotyped
drinking pattern with alcohol consumption taking
preference over other activities.
Complications
Medical complications include gastritis, peptic ulcer
disease, pancreatitis, hepatitis, cirrhosis, portal hypertensionwith
oesophageal varices, cardiomyopathy,
hypertension.
Neuropsychiatric complications: Acute withdrawal
(also known as delirium tremens) within 48 hours
may result in malaise, nausea, autonomic hyperactivity,
tremulousness, lability, insomnia, and transient
hallucinations, illusions especially visual (e.g. spiders),
frequent seizures. Serious delirium tremens has a significant
mortality.
Chronic dependence causesWernicke–Korsakoff psychosis
(see page 317).
Other neuropsychiatric complications include dementia,
peripheral neuropathy, cerebellar degeneration,
alcoholic hallucinations, symptoms of depression
and/or anxiety.
Social problems include job loss, marital difficulties,
criminal activity and alcohol-related accidents.
Investigations
Blood alcohol levels are of limited value, a persistently
raised MCV or γGT are suggestive of continued alcohol
use.

Management

1 Identification and advice at an early stage may be
enough to avert serious medical, neuropsychiatric
and social consequences of alcohol. Precipitating factors
should be identified and psychological support/
therapy instituted as appropriate.
2 Abstinence, individuals may require general support
(rehydration, correction of electrolyte imbalance,
complex intravenous vitamin preparations) and
treatment to avoid specific complications, e.g. chlordiazepoxide
in the treatment of delirium tremens
and diazepam or lorazepam in the treatment of
seizures.
3 Disulfiram (Antabuse) blocks metabolism resulting
in acetaldehyde accumulation resulting in flushing,
headache, anxiety and nausea. This may be implanted
to give 6 months of treatment
Prognosis
15% die by suicide, 30% continue to have life-long
alcohol-related problems

effects of alcohol on human body
Physical

Short-term effects

Drinking enough to cause a blood alcohol concentration (BAC) of 0.03–0.12% typically causes an overall improvement in mood and possible euphoria. increased self-confidence and sociability, decreased anxiety, a flushed, red appearance in the face and impaired judgment and fine muscle coordination. A BAC of 0.09% to 0.25% causes lethargy, sedation, balance problems and blurred vision. A BAC of 0.18% to 0.30% causes profound confusion, impaired speech .staggering, dizziness and vomiting. A BAC from 0.25% to 0.40% causes stupor, unconsciousness, anterograde amnesia, vomiting (death may occur due to inhalation of vomit (pulmonary aspiration) while unconscious and respiratory depression (potentially life-threatening). A BAC from 0.35% to 0.80% causes a coma (unconsciousness), life-threatening respiratory depression and possibly fatal alcohol poisoning.

Long-term effects

Drinking more than one drink a day for women or two drinks for men increases the risk of heart disease
, high blood pressure
, atrial fibrillation, and stroke,Risk is greater in younger people due to binge drinking which may result in violence or accidents
Long-term alcohol abuse can cause a number of physical symptoms, including cirrhosis of the liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, nutritional deficiencies, peptic ulcers and sexual dysfunction,
 some other long term effects  Examples of long-term complications include brain, heart, and liver damage. and an increased risk of breast cancer
. Additionally, heavy drinking over time has been found to have a negative effect on reproductive functioning in women. This results in reproductive dysfunction such as anovulation, decreased ovarian mass, problems or irregularity of the menstrual cycle, and early menopause Urine and blood tests

diagnosis of alcohol  

There are reliable tests for the actual use of alcohol, one common test being that of blood alcohol content (BAC).[126] These tests do not differentiate alcoholics from nonalcoholics however, long-term heavy drinking does have a few recognizable effects on the body, including
Macrocytosis (enlarged MCV)
Elevated GGT
Moderate elevation of AST and ALT and an AST: ALT ratio of 2:1
High carbohydrate deficient transferrin (CDT)
With regard to alcoholism, BAC is useful to judge alcohol tolerance, which in turn is sign of alcoholism.[4]
However, none of these blood tests for biological markers is as sensitive as screening questionnaires.

treatment  

Benzodiazepines

while useful in the management of acute alcohol withdrawal, if used long-term can cause a worse outcome in alcoholism. Alcoholics on chronic benzodiazepines have a lower rate of achieving abstinence from alcohol than those not taking benzodiazepines

Acamprosate

 may stabilise the brain chemistry that is altered due to alcohol dependence via antagonising the actions of glutamate, a neurotransmitter which is hyperactive in the post-withdrawal phase

Disulfiram

 prevents the elimination of acetaldehyde, a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many hangover symptoms from alcohol use

Naltrexone

 is a competitive antagonist for opioid receptors, effectively blocking the effects of endorphins and opioids. Naltrexone is used to decrease cravings for alcohol and encourage abstinence. Alcohol causes the body to release endorphins, which in turn release dopamine and activate the reward pathways; hence when naltrexone is in the body there is a reduction in the pleasurable effects from consuming alcohol

Calcium carbimide

works in the same way as disulfiram; it has an advantage in that the occasional adverse effects of disulfiram, hepatotoxicity and drowsiness, do not occur with calcium carbimide

Common signs and symptoms include:

Repeatedly neglecting your responsibilities

Using alcohol in situations where it’s physically dangerous, such as drinking and driving, operating machinery while intoxicated,

Experiencing repeated legal problems on account of your drinking
.
Continuing to drink even though your alcohol use is causing problems in your relationships.
Drinking as a way to relax or de-stress

Withdrawal symptoms include:

Anxiety or jumpiness
Shakiness or trembling
Sweating
Nausea and vomiting
Insomnia
Depression
Irritability
Fatigue
Loss of appetite
Headache

note in the above post there are only physical effect rather  than psychological effect and
include only  treatment by some drugs not at all and not psychological treatment