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Alcoholism and Substance Abuse

Explore the definitions, intoxication, addiction, tolerance, and withdrawal related to alcoholism and substance abuse. Learn about the epidemiology, etiology, diagnosis, and pathology of these conditions. Understand the physical and social factors contributing to alcohol dependence and substance abuse. Discover the diagnostic criteria for substance dependence and abuse, as well as other related disorders and complications.

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Alcoholism and Substance Abuse

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  1. Alcoholism and Substance Abuse

  2. Focus • Alcoholism

  3. Phenomenology • Definitions • Intoxication • Addiction • Tolerance • Physical Dependence • Withdrawal • Substance Dependence • Substance Abuse

  4. Intoxication • Reversible, • Substance-specific • physiological and behavioral changes • due to recent exposure to a psychoactive substance.

  5. Tolerance • The decline in potency • continued use • higher doses are needed for same effect. • Receptor mediated • Common

  6. Physical Dependence • The development of withdrawal symptoms once a drug is stopped.

  7. Withdrawal • A physiological state • Cessation/reduction in amount of drug • Generally opposite of drug’s normal effects.

  8. Addiction • Compulsion • Psychic, rather than therapeutic, effects

  9. Other Terms • Alcoholism • DSM-related terms • Substance dependence • Substance Abuse

  10. Epidemiology

  11. Substance Use

  12. Alcohol Dependence • Very common • ECA: ~14% • > 10 million Americans • Another 8 million “problem drinkers” • Only 3% “skid row”

  13. Epidemiology: Illicit Abuse (%)

  14. Alcohol Dependence • Gender • % >> & • Probably 2 types

  15. Alcohol Dependence: Age • More common in adults, but... • Teenage also common • 15% HS 5+ drinks/occasion/week • 31% HS intoxicated 6+/year • Under-Dx in elderly • ♂: alcohol • ♀: look for prescription drugs

  16. Alcohol Dependence: Social Factors • More common • Rural • Undereducated • Low socioeconomic • Less likely to drink • More likely to abuse

  17. Alcohol Dependence: Socioeconomics • Associated with • Unstable marriages • Increase risk divorce 3X • Unstable work

  18. Alcohol Dependence: Medical Ramifications • 20-50% hospital admissions • May be unrecognized • ~20% ER visits • 80% of cirrhosis • 33% of suicides

  19. Pathology

  20. Pathology of • Acute Physiological • Tolerance • Withdrawal • Addiction

  21. Etiology

  22. Etiology of Substance Abuse: Genetics • 1 parent: • 20% • 2 parents • 20-50% • sons of father • 50% • if severe alcoholic and criminal: • 90% risk in son.

  23. Genetics • Twins • fraternal:28% • identical: 54% • Adopted • Danish Adoption Study (1974) • adopted sons of alcoholics raised by non-alcoholic foster parents still had increased risk of alcoholism.

  24. Social Influences

  25. Diagnosis

  26. DiagnosisSubstance Dependence • Maladaptive pattern of substance use • $ 3 or more (1 year): • Tolerance • Withdrawal • larger amounts • Desire/Cut down • Time spent • Activities • Continued use

  27. DiagnosisSubstance Abuse • Maladaptive pattern • $ 1 (1 year) • recurrent use 6failed obligations • hazardous use • Legal problems • Continued use despite causing interpersonal or social problems. • R/O: Substance dependence

  28. Other Diagnoses • Substance Intoxication • Substance Withdrawal

  29. Diagnoses:Other substances • Alcohol • Amphetamines and related • Caffeine • Cannabis • Cocaine • Hallucinogens • Inhalants • Nicotine • Opioids • Phencyclidine and related • Sedatives • Polysubstance Abuse ($ 3) • Other

  30. Diagnosis • Other Schemas for Alcohol • Greek letters • Typologies

  31. Diagnosis • CAGE Questionnaire • Have you ever felt the need to Cut down on drinking • Have you ever felt Annoyed by criticisms of drinking • Have you ever had Guilty feelings about drinking • Have you ever taken a morning Eye opener

  32. Diagnosis • Clues • History • Physical • Labs

  33. Differential • Normal use • What’s normal?

  34. Comorbid Disorders and Complications • Alcohol Withdrawal • Uncomplicated • Seizures • Hallucinosis • DT’s

  35. Comorbid Disorders and Complications • Comorbid Medical Disorders • Comorbid Psychiatric Illnesses

  36. Course • Relapses and remission • Predictors • Gender • Age of onset • Family history

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