Conditions resulting from different patterns of alcohol consumption, including acute alcohol intoxication, harmful
alcohol use, alcohol dependence syndrome and alcohol withdrawal state.
Causes
- Genetic
- Social and environmental factors including availability
- Stress, peer pressure
- Personality disorders
Clinical features
Acute intoxication
- Transient condition following intake of alcohol resulting in disturbances of consciousness, cognition, perception, affect or behaviour
Harmful alcohol use
- Pattern of alcohol consumption that is causing damage to the health, physical (e.g. liver disease) or mental (e.g.
depressive disorder). Criteria:- More than 5 drinks in any given occasion in the last 12 months
- More than 2 drinks a day
- Drinking every day
- These patients consume more alcohol than recommended but they do not fulfil (yet) the criteria for alcohol
dependence
Alcohol consumption during pregnancy is extremely harmful for the baby: it can cause foetal alcohol syndrome.
Counsel against any consumption
Alcohol dependence
- A disorder characterised by the need to take large daily amounts of alcohol for adequate functioning. The use of
alcohol takes on a much higher priority for the individual than other behaviours that once had greater value - Complications: malnutrition, thiamine deficiency (causing Wernicke encephalopathy), liver disease, chronic
pancreatitis, peptic ulcer, cardiomyopathy, neuropathy, head trauma etc
Alcohol withdrawal
- Symptoms occurring upon cessation of alcohol after its prolonged daily use (6 hours to 6 days after)
- Tremor in hands, sweating, vomiting, tachycardia, hypertension, agitation, anxiety, headache, seizure and
confusion in severe cases
Diagnostic criteria for alcohol dependence:
If 3 or more of the features below are present:
- A strong desire to take alcohol
- Difficulties controlling alcohol use in terms of onset, termination or levels of use
- A physiological withdrawal state when alcohol use has ceased or been reduced (alcohol withdrawal syndrome)
- Evidence of tolerance: increased doses of alcohol are required to achieve effects originally produced by lower
doses - Progressive neglect of alternative pleasures or interests because of alcohol use
- Alcohol use persists despite clear evidence of harmful consequences e.g. liver damage, depression, cognitive
impairment, loss of a job, friends, relationships
Differential diagnosis
- Abuse of other psychoactive substances
- Depression, chronic psychosis (often co-existing!)
Investigations
- Blood: complete blood count, liver enzymes
- Shows elevated MCV and GGT levels
- Social investigations
Management
Acute intoxication, withdrawal and Wernicke’s encephalopathy
See section
Harmful alcohol consumption
- Counselling and advice
- Investigate and treat concurrent medical or psychiatric illness (dementia, depression anxiety,
psychosis etc.) - Follow up and refer if not better
Alcohol dependence
- Counselling and education of the patient
- Assess and manage concurrent medical and mental conditions
- Advise thiamine 100 mg daily
If patient willing to stop, facilitate alcohol cessation
- Determine appropriate setting, refer for detoxification, treat withdrawal symptoms with
diazepam - Consider referral to self help groups
- Counsel the family, provide psychosocial interventions if available
Prevention
- Health education on dangers of alcohol abuse
- Reduce accessibility to alcohol